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Paik JM, Shah D, Eberly K, Golabi P, Henry L, Younossi ZM. Changes in mortality due to Chronic Liver Diseases (CLD) during the COVID-19 pandemic: Data from the United States' National Vital Statistics System. PLoS One 2024; 19:e0289202. [PMID: 39226267 PMCID: PMC11371215 DOI: 10.1371/journal.pone.0289202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 07/13/2023] [Indexed: 09/05/2024] Open
Abstract
INTRODUCTION We assessed chronic liver disease (CLD)-related mortality in the U.S. using death data (2011-2021) obtained from National Vital Statistics System (NVSS). The average annual percentage change (AAPC) from the models selected by Joinpoint regression analysis over the pre-pandemic (2011-2019) and the 2019-2021 were reported because non-linear trend in death rates were observed over the 2011-2021. Liver-specific death was defined as an underlying cause of death and Chronic liver disease (CLD)-related death was defined as any cause of death. During the pre-pandemic, age-standardized HCC- and cirrhosis-specific death rates were annually increased by AAPC = +1.18% (95% confidence interval, 0.34% to 2.03%) and AAPC = +1.95% (1.56% to 2.35%). In contrast, during the 2019-2021, the AAPC in age-standardized cirrhosis-specific death rate (per 100,000) accelerated by up to AAPC +11.25% (15.23 in 2019 to 18.86 in 2021) whereas that in age-standardized HCC-specific death rate slowed to -0.39 (-1.32% to 0.54%) (3.86 in 2019 to 3.84 in 2021). Compared to HCC-specific deaths, cirrhosis-specific deaths were more likely to be non-Hispanic white (72.4% vs. 62.0%) and non-Hispanic American Indian and Alaska native (AIAN) (2.2% vs. 1.1%) and have NAFLD (45.3% vs. 12.5%) and ALD (27.6% vs. 22.0%). During the 2019-2021, the age-standardized HCV- and HBV-related death rate stabilized, whereas the age-standardized NAFLD- and ALD-related deaths rate increased to 20.16 in 2021 (AAPC = +12.13% [7.76% to 16.68%]) and to 14.95 in 2021 (AAPC = +18.30% [13.76% to 23.03%]), which were in contrast to much smaller incremental increases during the pre-pandemic (AAPC = +1.82% [1.29% to 2.35%] and AAPC = +4.54% [3.97% to 5.11%]), respectively). The most pronounced rise in the age-standardized NAFLD-related death rates during the pandemic was observed among AIAN (AAPC = +25.38%), followed by non-Hispanic White female (AAPC = +14.28%), whereas the age-standardized ALD-related death rates during the pandemic were highest among AIAN (AAPC = +40.65%), followed by non-Hispanic Black female (AAPC = +26.79%). CONCLUSIONS COVID-19 pandemic had a major negative impact on cirrhosis-specific and CLD-related mortality in the U.S. with significant racial and gender disparities.
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Affiliation(s)
- James M. Paik
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, United States of America
- Center for Liver Disease, Department of Medicine, Inova Fairfax Medical Campus, Falls Church, VA, United States of America
| | - Dipam Shah
- Center for Liver Disease, Department of Medicine, Inova Fairfax Medical Campus, Falls Church, VA, United States of America
| | - Katherine Eberly
- Center for Liver Disease, Department of Medicine, Inova Fairfax Medical Campus, Falls Church, VA, United States of America
| | - Pegah Golabi
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, United States of America
- Center for Liver Disease, Department of Medicine, Inova Fairfax Medical Campus, Falls Church, VA, United States of America
| | - Linda Henry
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, United States of America
- Center for Liver Disease, Department of Medicine, Inova Fairfax Medical Campus, Falls Church, VA, United States of America
- Center for Outcomes Research, Washington DC, United States of America
| | - Zobair M. Younossi
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, United States of America
- Center for Liver Disease, Department of Medicine, Inova Fairfax Medical Campus, Falls Church, VA, United States of America
- Inova Medicine, Inova Health System, Falls Church, VA, United States of America
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Vu HT, Nguyen VD, Ikenaga H, Matsubara T. Application of PPAR Ligands and Nanoparticle Technology in Metabolic Steatohepatitis Treatment. Biomedicines 2024; 12:1876. [PMID: 39200340 PMCID: PMC11351628 DOI: 10.3390/biomedicines12081876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Revised: 08/10/2024] [Accepted: 08/13/2024] [Indexed: 09/02/2024] Open
Abstract
Metabolic dysfunction-associated steatotic liver disease/steatohepatitis (MASLD/MASH) is a major disease worldwide whose effective treatment is challenging. Peroxisome proliferator-activated receptors (PPARs) belong to the nuclear receptor superfamily and function as ligand-activated transcription factors. To date, three distinct subtypes of PPARs have been characterized: PPARα, PPARβ/δ, and PPARγ. PPARα and PPARγ are crucial regulators of lipid metabolism that modulate the transcription of genes involved in fatty acid (FA), bile acid, and cholesterol metabolism. Many PPAR agonists, including natural (FAs, eicosanoids, and phospholipids) and synthetic (fibrate, thiazolidinedione, glitazar, and elafibranor) agonists, have been developed. Furthermore, recent advancements in nanoparticles (NPs) have led to the development of new strategies for MASLD/MASH therapy. This review discusses the applications of specific cell-targeted NPs and highlights the potential of PPARα- and PPARγ-targeted NP drug delivery systems for MASLD/MASH treatment.
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Affiliation(s)
- Hung Thai Vu
- Department of Anatomy and Regenerative Biology, Graduate School of Medicine, Osaka Metropolitan University, Osaka 545-8585, Osaka, Japan; (H.T.V.); (V.D.N.)
| | - Vien Duc Nguyen
- Department of Anatomy and Regenerative Biology, Graduate School of Medicine, Osaka Metropolitan University, Osaka 545-8585, Osaka, Japan; (H.T.V.); (V.D.N.)
| | - Hiroko Ikenaga
- Department of Hepatology, Graduate School of Medicine, Osaka Metropolitan University, Osaka 545-8585, Osaka, Japan
| | - Tsutomu Matsubara
- Department of Anatomy and Regenerative Biology, Graduate School of Medicine, Osaka Metropolitan University, Osaka 545-8585, Osaka, Japan; (H.T.V.); (V.D.N.)
- Research Institute for Light-induced Acceleration System (RILACS), Osaka Metropolitan University, Sakai 599-8570, Osaka, Japan
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Huang A, Zou C, Dai Z, Sun Y, Wang J, Liu S, Han L, Chen S, Liang Q, Wang C, Zhuang Y, Dang T, Chang B, Wang Y, Zou Z. Mild-moderate alcohol consumption and diabetes are associated with liver fibrosis in patients with biopsy-proven MASLD. Front Pharmacol 2024; 15:1437479. [PMID: 39144624 PMCID: PMC11322122 DOI: 10.3389/fphar.2024.1437479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Accepted: 07/17/2024] [Indexed: 08/16/2024] Open
Abstract
Background It is unclear whether patients with metabolic dysfunction-associated steatotic liver disease (MASLD) are allowed variable low levels of alcohol. This study aimed to evaluate the effect of mild-moderate alcohol consumption on the biochemical and histological characteristics of patients with MASLD. Methods Alcohol consumption was assessed in 713 patients with steatotic liver disease (SLD) who underwent liver biopsy. Non-drinking, mild-moderate drinking, and excessive drinking were defined as 0 g/day, 1-<20 g/day, and >20 g/day for women and 0 g/day, 1-<30 g/day, and >30 g/day for men, respectively. Liver biopsies were scored according to the NASH CRN system. Results A total of 713 participants (median age 39.0 years and 77.1% male) with biopsy-proven SLD were enrolled, including 239 nondrinkers, 269 mild-moderate drinkers and 205 excessive drinkers. Excessive drinking was associated with increased risks for lobular inflammation and liver fibrosis compared to nondrinkers and mild-moderate drinkers. Compared with non-drinkers, mild-moderate drinkers had significantly lower odds for steatosis (OR = 0.60, 95% CI = 0.38-0.93, p = 0.025), hepatocellular ballooning (OR = 0.52, 95% CI = 0.29-0.91, p = 0.020) and fibrosis (OR = 0.50, 95% CI = 0.31-0.81, p = 0.005). However, in non-excessive drinkers with type 2 diabetes mellitus (T2DM), there was no association between mild-moderate alcohol consumption and liver fibrosis (OR = 0.562, 95% CI = 0.207-1.530, p = 0.257). Conclusions Mild-moderate alcohol consumption might be protective against liver fibrosis in MASLD patients, which is modified by the presence of T2DM. However, further longitudinal studies are needed to determine the effect of ongoing alcohol consumption on disease severity.
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Affiliation(s)
- Ang Huang
- Department of Hepatology, The Fifth Medical Center of PLA General Hospital, Beijing, China
- Department of Gastroenterology and Hepatology, The First Medical Center of PLA General Hospital, Beijing, China
| | - Cailun Zou
- Department of Gastroenterology, China-Japan Friendship Hospital, Beijing, China
| | - Zhe Dai
- School of Medicine, Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Ying Sun
- Department of Hepatology, The Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Jing Wang
- Inner Mongolia Institute of Digestive Diseases, The Second Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, Baotou, China
| | - Shuhong Liu
- Department of Pathology and Hepatology, The Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Lin Han
- Department of Hepatology, The Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Songhai Chen
- Department of Hepatology, The Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Qingsheng Liang
- Department of Hepatology, The Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Chunyan Wang
- Department of Hepatology, The Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Yingjie Zhuang
- Department for Disease Control and Prevention, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Tong Dang
- School of Medicine, Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Binxia Chang
- Department of Hepatology, The Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Yijin Wang
- School of Medicine, Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Zhengsheng Zou
- Department of Hepatology, The Fifth Medical Center of PLA General Hospital, Beijing, China
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Tran S, Zou B, Lee K, Kam L, Yeo Y, Henry L, Cheung R, Nguyen MH. Updates in characteristics and survival rates of cirrhosis in a nationwide cohort of real-world U.S. patients, 2003-2021. Aliment Pharmacol Ther 2024; 60:212-223. [PMID: 38693757 DOI: 10.1111/apt.18024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/05/2023] [Accepted: 04/17/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Adverse outcomes of cirrhosis remain a top priority. AIMS We examined the distribution of cirrhosis causes, HCC incidence and mortality and related changes over time in a nationwide U.S. COHORT METHODS A retrospective study of a national sample of commercially insured patients with cirrhosis from Optum's de-identified Clinformatics® Data Mart Database (CDM). RESULTS A total of 628,743 cirrhosis cases were identified with 45% having NAFLD, 19.5% HCV, and 16.3% ALD. African Americans had the highest rate of decompensation (60.6%), while Asians had the highest rate of HCC (2.4%), both p < 0.001. African Americans more frequently had HCV (28.4%) while Hispanic/Latinos more frequently had NAFLD (49.2%, p < 0.001). Patients in the 2014-2021 cohort were significantly older (63.0 ± 12.8 vs. 57.0 ± 14.3), less frequently decompensated (54.5% vs. 58.3%) but more frequently had HCC (1.7% vs. 0.6%) and NAFLD (46.5% vs. 44.2%), all p < 0.001. The overall annual incidence of HCC was 0.76% (95% CI: 0.75-0.77) with a 5-year cumulative incidence of 4.03% (95% CI: 3.98-4.09), with significant variation by sex, race/ethnicity, and cirrhosis aetiology. The overall median years of survival were 11.4 (95% CI: 11.3-11.5) with a 5-year cumulative survival of 73.4% (95% CI: 73.3%-73.6%), also with significant disparities in similar subgroups (lowest in cryptogenic cirrhosis and worse in 2014-2021 vs. 2003-2013). The 2014-2021 period was independently associated with worse survival (aHR: 1.14, 95% CI: 1.08-1.20). CONCLUSIONS HCC incidence and survival vary by aetiology among patients with cirrhosis, with cryptogenic cirrhosis having the lowest survival and lower survival in the more recent time period.
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Affiliation(s)
- Sally Tran
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, USA
| | - Biyao Zou
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Palo Alto, California, USA
| | - KeeSeok Lee
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, USA
| | - Leslie Kam
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, USA
| | - YeeHui Yeo
- Division of General Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Linda Henry
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, USA
| | - Ramsey Cheung
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, USA
- Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Mindie H Nguyen
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Palo Alto, California, USA
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Bozhkov AI, Akzhyhitov RA, Bilovetska SG, Ivanov EG, Dobrianska NI, Bondar AY. The Effect of Retinol Acetate on Liver Fibrosis Depends on the Temporal Features of the Development of Pathology. J Clin Exp Hepatol 2024; 14:101338. [PMID: 38264572 PMCID: PMC10801314 DOI: 10.1016/j.jceh.2023.101338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 12/19/2023] [Indexed: 01/25/2024] Open
Abstract
Background The effect of vitamin A on the manifestations of liver fibrosis is controversial and establishing the causes of its multidirectional influence is an urgent problem. In the work, the functional characteristics of the liver with Cu-induced fibrosis were determined after the restoration of vitamin A to the control level at the F0/F1 stage. Methods In animals with liver fibrosis, classical indicators of physiology, functional activity of the liver, histological, and hematological characteristics were determined; the content of calcium and ROS was determined in bone marrow cells. Results It was shown that in the liver with Cu-induced fibrosis, the restoration of vitamin A content to control values after per os injections of a retinol acetate solution at a dose of 0.10 mg (300 IU)/100 g of body weight in the early stages of this pathology development (Fо/F1) was accompanied by: a decrease in the number of immunocompetent cells in the bloodstream to control values; normalization of the amount of calcium ions and ROS in bone marrow cells; restoration to the control level of activity of alkaline phosphatase; an increase in the number of binuclear hepatocytes; and restoration of the dynamics of body weight growth in experimental animals, even against the background of the ongoing action of the hepatotoxic factor. Conclusion We came to the conclusion that the multidirectional action of vitamin A, which occurs in liver fibrosis, depends not only on the concentration of vitamin A in the liver but also on temporal characteristics of cellular and metabolic links involved in the adaptive response formation. It was suggested that knowledge of the initial temporal metabolic characteristics and the amount of vitamin A in the liver, taking into account the stages of fibrosis development, can be an effective way to restore the altered homeostatic parameters of the body.
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Affiliation(s)
- Anatoly I. Bozhkov
- Biology Research Institute V. N. Karazin Kharkiv National University, 4 Svobody Sq., Kharkiv, 61022, Ukraine
| | - Rustam A. Akzhyhitov
- Biology Research Institute V. N. Karazin Kharkiv National University, 4 Svobody Sq., Kharkiv, 61022, Ukraine
| | - Svitlana G. Bilovetska
- Biology Research Institute V. N. Karazin Kharkiv National University, 4 Svobody Sq., Kharkiv, 61022, Ukraine
| | - Evgeny G. Ivanov
- Biology Research Institute V. N. Karazin Kharkiv National University, 4 Svobody Sq., Kharkiv, 61022, Ukraine
| | - Nataliia I. Dobrianska
- Biology Research Institute V. N. Karazin Kharkiv National University, 4 Svobody Sq., Kharkiv, 61022, Ukraine
| | - Anastasiia Yu Bondar
- Biology Research Institute V. N. Karazin Kharkiv National University, 4 Svobody Sq., Kharkiv, 61022, Ukraine
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Zoncapè M, Liguori A, Tsochatzis EA. Non-invasive testing and risk-stratification in patients with MASLD. Eur J Intern Med 2024; 122:11-19. [PMID: 38246813 DOI: 10.1016/j.ejim.2024.01.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 01/12/2024] [Accepted: 01/14/2024] [Indexed: 01/23/2024]
Abstract
The development and validation of non-invasive fibrosis tests (NITs) has changed clinical practice in Hepatology over the last 15 years. Metabolic associated steatotic liver disease (MASLD), formerly known as non-alcoholic fatty liver disease (NAFLD), is the most prevalent liver disease in western countries, with up to a third of the unselected adult population affected. In this article, we review the use of NITs in the diagnosis and staging of MASLD. We discuss their use in the diagnosis of steatosis, steatohepatitis and fibrosis and critically evaluate recently published data. These NITs include a variety of approaches, such as serum markers like FIB-4, pro-C3 and ELF, imaging techniques like Fibroscan® and MRE, and combined scores like Agile 3+ and Agile 4, offering a range of options for healthcare providers. Furthermore, these non-invasive tests also serve as valuable prognostic tools, allowing for better risk assessment and improved patient management, particularly in predicting liver-related events and overall mortality.
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Affiliation(s)
- Mirko Zoncapè
- Sheila Sherlock Liver Unit, Royal Free Hospital, London, UK; UCL Institute for Liver and Digestive Health, University College London, UK; Liver Unit, Department of Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Antonio Liguori
- Sheila Sherlock Liver Unit, Royal Free Hospital, London, UK; UCL Institute for Liver and Digestive Health, University College London, UK; Medical and Surgical Sciences Department, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Emmanuel A Tsochatzis
- Sheila Sherlock Liver Unit, Royal Free Hospital, London, UK; UCL Institute for Liver and Digestive Health, University College London, UK.
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Kim RG, Patel S, Satre DD, Shumway M, Chen JY, Magee C, Wong RJ, Monto A, Cheung R, Khalili M. Telehepatology Satisfaction Is Associated with Ethnicity: The Real-World Experience of a Vulnerable Population with Fatty Liver Disease. Dig Dis Sci 2024; 69:732-742. [PMID: 38217682 PMCID: PMC10960743 DOI: 10.1007/s10620-023-08222-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 11/28/2023] [Indexed: 01/15/2024]
Abstract
BACKGROUND Since the coronavirus disease 2019 (COVID-19) pandemic began, telemedicine use has transformed healthcare delivery. Yet there is concern that telemedicine may widen care disparities for vulnerable populations, and patient experience data are limited. AIMS We aimed to assess patient satisfaction with hepatology-related telemedicine (telehepatology) for delivery of fatty liver disease (FLD) care in a safety-net healthcare system. METHODS Adult patients with FLD were surveyed regarding satisfaction with telehepatology. Clinical, demographic, resources, and social determinants of health (SDoH) data were collected to identify factors associated with satisfaction through multivariable modeling. RESULTS From June 2020 to March 2022, 220 participants were enrolled: the median age was 52 years, 37% were men, and 68% were Hispanic. One hundred nineteen (54%) had prior telehepatology experience. Overall, satisfaction was high; 70% reported being somewhat or very satisfied. On univariate analysis, Hispanic ethnicity (versus non-Hispanic, OR 0.34, 95% CI 0.1-0.9, p = 0.03) and limited access to personal cellphone/internet (OR 0.16, 95% CI 0.04-0.6, p = 0.01) were associated with lower satisfaction. On multivariable logistic regression modeling adjusted for pandemic duration, age, sex, severity of liver disease, and coexisting liver disease, Hispanic ethnicity and lack of personal cellphone/internet remained independently associated with lower telehepatology satisfaction (OR 0.24, 95% CI 0.07-0.9, p = 0.03 and OR 0.2, 95% CI 0.04-0.9, p = 0.04, respectively). The association remained statistically significant after inclusion of various SDoH in the multivariable model. CONCLUSIONS Satisfaction with telehepatology among FLD patients in a safety-net clinical setting was high overall. However, Hispanic ethnicity and lack of personal cellphone/internet were independently associated with lower telehepatology satisfaction. A better understanding of patients' experience with telehepatology is needed to identify reasons for dissatisfaction, and in-person visits should remain an option for patients to ensure equitable care.
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Affiliation(s)
- Rebecca G Kim
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Shyam Patel
- School of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Division of Gastroenterology and Hepatology, Zuckerberg San Francisco General, San Francisco, CA, USA
| | - Derek D Satre
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Martha Shumway
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Jennifer Y Chen
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Division of Gastroenterology and Hepatology, Zuckerberg San Francisco General, San Francisco, CA, USA
| | - Catherine Magee
- Division of Gastroenterology and Hepatology, Zuckerberg San Francisco General, San Francisco, CA, USA
| | - Robert J Wong
- Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Alexander Monto
- Division of Gastroenterology and Hepatology, Veterans Affairs San Francisco Health Care System, San Francisco, CA, USA
| | - Ramsey Cheung
- Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Mandana Khalili
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
- Division of Gastroenterology and Hepatology, Zuckerberg San Francisco General, San Francisco, CA, USA.
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Lurje I, Hammerich L. The suppressive tumor microenvironment of AFP-positive hepatocellular carcinoma and its therapeutic implications. Transl Gastroenterol Hepatol 2023; 9:1. [PMID: 38317743 PMCID: PMC10838608 DOI: 10.21037/tgh-23-81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 12/04/2023] [Indexed: 02/07/2024] Open
Affiliation(s)
- Isabella Lurje
- Department of Hepatology and Gastroenterology, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Linda Hammerich
- Department of Hepatology and Gastroenterology, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Yamashiki N, Kawabata K, Murata M, Ikeda S, Fujimaki T, Suwa K, Seki T, Aramaki E, Naganuma M. Narrowing the Patient-Physician Gap Based on Self-Reporting and Monthly Hepatologist Feedback for Patients With Alcohol-Related Liver Disease: Interventional Pilot Study Using a Journaling Smartphone App. JMIR Form Res 2023; 7:e44762. [PMID: 38113066 PMCID: PMC10762609 DOI: 10.2196/44762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 01/16/2023] [Accepted: 11/20/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Screening and intervention for alcohol use disorders (AUDs) are recommended to improve the prognosis of patients with alcohol-related liver disease (ALD). Most patients' smartphone app diaries record drinking behavior for self-monitoring. A smartphone app can be expected to also be helpful for physicians because it can provide rich patient information to hepatologists, leading to suitable feedback. We conducted this prospective pilot study to assess the use of a smartphone app as a journaling tool and as a self-report-based feedback source for patients with ALD. OBJECTIVE The aims of this study were assessment of whether journaling (self-report) and self-report-based feedback can help patients maintain abstinence and improve liver function data. METHODS This pilot study used a newly developed smartphone journaling app for patients, with input data that physicians can review. After patients with ALD were screened for harmful alcohol use, some were invited to use the smartphone journaling app for 8 weeks. Their self-reported alcohol intake, symptoms, and laboratory data were recorded at entry, week 4, and week 8. Biomarkers for alcohol use included gamma glutamyl transferase (GGT), percentage of carbohydrate-deficient transferrin to transferrin (%CDT), and GGT-CDT (GGT-CDT= 0.8 × ln[GGT] + 1.3 × ln[%CDT]). At each visit, their recorded data were reviewed by a hepatologist to evaluate changes in alcohol consumption and laboratory data. The relation between those outcomes and app usage was also investigated. RESULTS Of 14 patients agreeing to participate, 10 completed an 8-week follow-up, with diary input rates between 44% and 100% of the expected days. Of the 14 patients, 2 withdrew from clinical follow-up, and 2 additional patients never used the smartphone journaling app. Using the physician's view, a treating hepatologist gave feedback via comments to patients at each visit. Mean self-reported alcohol consumption dropped from baseline (100, SD 70 g) to week 4 (13, SD 25 g; P=.002) and remained lower at week 8 (13, SD 23 g; P=.007). During the study, 5 patients reported complete abstinence. No significant changes were found in mean GGT and mean %CDT alone, but the mean GGT-CDT combination dropped significantly from entry (5.2, SD 1.2) to the week 4 visit (4.8, SD 1.1; P=.02) and at week 8 (4.8, SD 1.0; P=.01). During the study period, decreases in mean total bilirubin (3.0, SD 2.4 mg/dL to 2.4, SD 1.9 mg/dL; P=.01) and increases in mean serum albumin (3.0, SD 0.9 g/dL to 3.3, SD 0.8 g/dL; P=.009) were recorded. CONCLUSIONS These pilot study findings revealed that a short-term intervention with a smartphone journaling app used by both patients and treatment-administering hepatologists was associated with reduced drinking and improved liver function. TRIAL REGISTRATION UMIN CTR UMIN000045285; http://tinyurl.com/yvvk38tj.
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Affiliation(s)
- Noriyo Yamashiki
- Department of Gastroenterology and Hepatology, Kansai Medical University Medical Center, Osaka, Japan
- The Third Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kansai Medical University, Osaka, Japan
| | - Kyoko Kawabata
- Graduate School of Science and Technology, Nara Institute of Science and Technology, Ikoma, Japan
| | - Miki Murata
- Department of Gastroenterology and Hepatology, Kansai Medical University Medical Center, Osaka, Japan
- The Third Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kansai Medical University, Osaka, Japan
| | - Shunichiro Ikeda
- Department of Psychiatry, Kansai Medical University, Osaka, Japan
| | - Takako Fujimaki
- Graduate School of Science and Technology, Nara Institute of Science and Technology, Ikoma, Japan
| | - Kanehiko Suwa
- Department of Gastroenterology and Hepatology, Kansai Medical University Medical Center, Osaka, Japan
- The Third Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kansai Medical University, Osaka, Japan
| | - Toshihito Seki
- Department of Gastroenterology and Hepatology, Kansai Medical University Medical Center, Osaka, Japan
| | - Eiji Aramaki
- Graduate School of Science and Technology, Nara Institute of Science and Technology, Ikoma, Japan
| | - Makoto Naganuma
- The Third Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kansai Medical University, Osaka, Japan
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Liu X, Wang Y, Liu X, Zeng B, Zhu B, Zhang Y, Zhuang Y, Zhang Y, Dai F. Higher oxidative balance scores are associated with lower nonalcoholic fatty liver disease and not with fibrosis in US adults. Nutr Metab Cardiovasc Dis 2023; 33:2488-2496. [PMID: 37798234 DOI: 10.1016/j.numecd.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/11/2023] [Accepted: 08/04/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND AND AIMS Little research have focused on the relationship between systemic oxidative stress status and NAFLD and fibrosis. The Oxidative Balance Score (OBS) is employed to evaluate whole-body lifestyle and diet exposures related to oxidative stress, with higher OBS scores implying exposure to more antioxidants. This study aimed to explore whether OBS is correlated with NAFLD and NAFLD-related fibrosis. METHODS AND RESULTS 12,223 participants from NHANES 2003-2018 were enrolled in this study. NAFLD was defined as USFLI ≥30 and liver fibrosis was determined as FIB-4 ≥ 2.67. OBS was scored by 20 lifestyle and dietary factors. Weighted logistic regression and restricted cubic splines were used to assess the association between OBS and NAFLD and fibrosis. The prevalence of NAFLD was 29.67%. There was a significant negative correlation between OBS, dietary OBS, lifestyle OBS and NAFLD and no correlation with NAFLD-related fibrosis. Compared to the lowest quartile, the adjusted ORs for the highest quartile of OBS, lifestyle OBS, dietary OBS and NAFLD were 0.55(95%CI:0.35,0.85), 0.12(95%CI:0.08,0.16), 0.70(95%CI:0.52,0.94) respectively. In stratified analyses, lifestyle OBS was negatively associated with NAFLD across gender, dietary OBS was only negatively correlated with NAFLD in men, and any OBS was not observed to be relevant to NAFLD-related fibrosis. CONCLUSIONS OBS was negatively associated with NAFLD, but not with NAFLD-related fibrosis. The findings underline the significance of adhering to an antioxidant lifestyle and diet, which can help prevent NAFLD but seems to be ineffective in preventing fibrosis in individuals with NAFLD.
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Affiliation(s)
- Xuna Liu
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, China
| | - Yiwen Wang
- Department of Cardiology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, China
| | - Xuyan Liu
- Department of Medicine, Northwest Minzu University, Lanzhou, 730030, China
| | - Beibei Zeng
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, China
| | - Boxu Zhu
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, China
| | - Yue Zhang
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, China
| | - Yan Zhuang
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, China
| | - Yanqi Zhang
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, China
| | - Fei Dai
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, China.
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11
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Upadhyay KK, Du X, Chen Y, Buscher B, Chen VL, Oliveri A, Zhao R, Speliotes EK, Brady GF. A common variant that alters SUN1 degradation associates with hepatic steatosis and metabolic traits in multiple cohorts. J Hepatol 2023; 79:1226-1235. [PMID: 37567366 PMCID: PMC10618955 DOI: 10.1016/j.jhep.2023.07.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 07/03/2023] [Accepted: 07/13/2023] [Indexed: 08/13/2023]
Abstract
BACKGROUND & AIMS Non-alcoholic fatty liver disease (NAFLD), and its progressive form steatohepatitis (NASH), represent a genetically and phenotypically diverse entity for which there is no approved therapy, making it imperative to define the spectrum of pathways contributing to its pathogenesis. Rare variants in genes encoding nuclear envelope proteins cause lipodystrophy with early-onset NAFLD/NASH; we hypothesized that common variants in nuclear envelope-related genes might also contribute to hepatic steatosis and NAFLD. METHODS Using hepatic steatosis as the outcome of interest, we performed an association meta-analysis of nuclear envelope-related coding variants in three large discovery cohorts (N >120,000 participants), followed by phenotype association studies in large validation cohorts (N >600,000) and functional testing of the top steatosis-associated variant in cell culture. RESULTS A common protein-coding variant, rs6461378 (SUN1 H118Y), was the top steatosis-associated variant in our association meta-analysis (p <0.001). In ancestrally distinct validation cohorts, rs6461378 associated with histologic NAFLD and with NAFLD-related metabolic traits including increased serum fatty acids, type 2 diabetes, hypertension, cardiovascular disease, and decreased HDL. SUN1 H118Y was subject to increased proteasomal degradation relative to wild-type SUN1 in cells, and SUN1 H118Y-expressing cells exhibited insulin resistance and increased lipid accumulation. CONCLUSIONS Collectively, these data support a potential causal role for the common SUN1 variant rs6461378 in NAFLD and metabolic disease. IMPACT AND IMPLICATIONS Non-alcoholic fatty liver disease (NAFLD), with an estimated global prevalence of nearly 30%, is a growing cause of morbidity and mortality for which there is no approved pharmacologic therapy. Our data provide a rationale for broadening current concepts of NAFLD genetics and pathophysiology to include the nuclear envelope, and particularly Sad1 and UNC84 domain containing 1 (SUN1), as novel contributors to this common liver disease. Furthermore, if future studies confirm causality of the common SUN1 H118Y variant, it has the potential to become a broadly relevant therapeutic target in NAFLD and metabolic disease.
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Affiliation(s)
- Kapil K Upadhyay
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Ann Arbor, Michigan, USA
| | - Xiaomeng Du
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Ann Arbor, Michigan, USA
| | - Yanhua Chen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Ann Arbor, Michigan, USA
| | - Brandon Buscher
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Ann Arbor, Michigan, USA
| | - Vincent L Chen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Ann Arbor, Michigan, USA
| | - Antonino Oliveri
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Ann Arbor, Michigan, USA
| | - Raymond Zhao
- University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Elizabeth K Speliotes
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Ann Arbor, Michigan, USA; Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, Michigan, USA
| | - Graham F Brady
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Ann Arbor, Michigan, USA.
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12
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Zahran RF, El-Sayed LM, Hoye TR, Ayyad SEN. The Dual Therapeutic Potential of Ottelione A on Carbon Tetrachloride-induced Hepatic Toxicity in Mice. Appl Biochem Biotechnol 2023; 195:5966-5979. [PMID: 36729297 PMCID: PMC10511377 DOI: 10.1007/s12010-023-04346-8] [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] [Accepted: 01/10/2023] [Indexed: 02/03/2023]
Abstract
BACKGROUND Some herbal natural products play an important role in protecting organisms from the toxic effect of some xenobiotics. The present study was designed to evaluate the potential therapeutic effects of Ottelione A (OTTE) against carbon tetrachloride(CCl4)-induced toxicity in mice. METHODS Adult male Swiss albino mice were divided into six groups: group I was used as a normal control received olive oil; group II received DMSO; group III received OTTE; group IV received CCl4 in olive oil, (injected i.p) 3 times/week for 6 weeks; group V received the same CCl4 regimen as group IV followed by OTTE injected for 15 days, and group VI first received OTTE injected for 15 days followed by the same CCl4 regimen as group IV. Some biochemical and histological parameters were investigated. RESULTS Our results showed that the administration of CCl4 caused hepatotoxicity, as monitored by the significant increase in biochemical parameters concerning the olive oil group. Treatment with OTTE appeare d to be effective against hepatotoxic and liver changes induced by CCl4, as evidenced by the improvement of the same parameters. CONCLUSION Ottelione A (OTTE) has good antioxidant and therapeutic properties, which can help in preventing CCl4-induced hepatotoxicity in both pre-treatment and post-treatment modes.
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Affiliation(s)
- Rasha Fekry Zahran
- Biochemistry division, Chemistry Department, Faculty of Science, Damietta University, 34517, Damietta, New-Damietta, Egypt.
| | - Lina Mahmoud El-Sayed
- Biochemistry division, Chemistry Department, Faculty of Science, Damietta University, 34517, Damietta, New-Damietta, Egypt
| | - Thomas Robert Hoye
- Departments of Chemistry and Medicinal Chemistry, University of Minnesota, 55455, Minneapolis, MN, USA
| | - Seif-Eldin Nasr Ayyad
- Department of Chemistry, Faculty of Science, Damietta University, New Damietta, Egypt
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13
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Xiao L, Li M, Xiao Y, Yu L, Li Y, Zhang Z, Zhang G, Li Y, Zhou L, Liang Y. Echinocystic acid prevents obesity and fatty liver via interacting with FABP1. Phytother Res 2023; 37:3617-3630. [PMID: 37092723 DOI: 10.1002/ptr.7839] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/24/2023] [Accepted: 04/07/2023] [Indexed: 04/25/2023]
Abstract
Long-term high-fat diet (HFD) will lead to obesity and their complications. Echinocystic acid (EA), a triterpene, shows anti-inflammatory and antioxidant effects. We predict that EA supplementation can prevent obesity, diabetes, and nonalcoholic steatohepatitis. To test our hypothesis, we investigated the effects of EA supplementation on mice with HFD-induced obesity in vivo and in vitro by adding EA to the diet of mice and the medium of HepG2 cells, the protein target of EA was analyzed by molecular docking. The results showed that EA ameliorated obesity and inhibited blood triglyceride and liver triglyceride concentrations than those in the HFD groups. The data on molecular docking indicated that FABP1 was a potential target of EA. Further experimental results confirmed that EA affected the triglyceride level by regulating the function of FABP1. This study may provide a new potential inhibitor for FABP1 and a new strategy for the treatment of obesity.
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Affiliation(s)
- Lianggui Xiao
- Guangxi Academy of Medical Sciences, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Mingming Li
- Guangxi Academy of Medical Sciences, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Yang Xiao
- Guangxi Academy of Medical Sciences, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Lin Yu
- Guangxi Academy of Medical Sciences, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Yu Li
- College of Animal Science and Technology, Guangxi University, Nanning, China
| | - Zhiwang Zhang
- Guangxi Academy of Medical Sciences, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Guo Zhang
- Guangxi Academy of Medical Sciences, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Yixing Li
- College of Animal Science and Technology, Guangxi University, Nanning, China
| | - Lei Zhou
- Guangxi Academy of Medical Sciences, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Yunxiao Liang
- Guangxi Academy of Medical Sciences, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
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14
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Allen AM, Lazarus JV, Younossi ZM. Healthcare and socioeconomic costs of NAFLD: A global framework to navigate the uncertainties. J Hepatol 2023; 79:209-217. [PMID: 36740046 PMCID: PMC10293095 DOI: 10.1016/j.jhep.2023.01.026] [Citation(s) in RCA: 40] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 01/20/2023] [Accepted: 01/26/2023] [Indexed: 02/07/2023]
Abstract
Left unaddressed, non-alcoholic fatty liver disease (NAFLD) will continue to have substantial health, economic and social implications. To address the challenge, a paradigm shift is needed in the way NAFLD is conceptualised. Concerted, collaborative action across medical specialities, industry sectors and governments will be vital in tackling this public health threat. To drive this change, in this review, we present data on the current global healthcare and socioeconomic costs of NAFLD and highlight priority actions. The estimated healthcare costs of patients with NAFLD are nearly twice as high as their age-matched counterparts without the disease and are highest in those with advanced fibrosis and end-stage liver disease. NAFLD is accountable for the highest increase in DALYs (disability-adjusted life years) among all liver diseases globally. NAFLD and non-alcoholic steatohepatitis (NASH)-specific drug therapies are not yet available and there is considerable uncertainty regarding cost, optimal length of treatment, and their impact on liver-related outcomes and mortality. Among the currently available bariatric procedures, sleeve gastrectomy is reported to be the most cost-effective for NASH resolution. Gastric bypass remains very expensive, while data on bariatric endoscopy are limited. Lastly, we propose a global NAFLD/NASH investment framework to guide the development of achievable yet ambitious country-specific targets and strategic actions to optimise resource allocation and reduce the prevalence of NAFLD and NASH. Its focus on high-level inputs will be critical to enabling a political and financial environment that supports clinical-level implementation of NAFLD prevention, treatment and care efforts, across all settings.
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Affiliation(s)
- Alina M Allen
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain; Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain; CUNY Graduate School of Public Health and Health Policy, New York, NY, USA
| | - Zobair M Younossi
- Center for Liver Diseases, Inova Medicine, Falls Church, Virginia, USA
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15
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Li Y, Ou Z, Yu D, He H, Zheng L, Chen J, Chen C, Xiong H, Chen Q. The trends in death of primary liver cancer caused by specific etiologies worldwide: results from the Global Burden of Disease Study 2019 and implications for liver cancer management. BMC Cancer 2023; 23:598. [PMID: 37380957 DOI: 10.1186/s12885-023-11038-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 06/04/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND Over past decades, epidemiological patterns of liver cancer (LC) have changed dramatically. The Global Burden of Disease (GBD) study provides an opportunity for tracking the progress in cancer control with its annual updated reports at national, regional and global level, which can facilitate the health decision-making and the allocation of health resources. Therefore, we aim to estimate the global, regional and national trends of death caused by liver cancer due to specific etiologies and attributable risks from 1990 to 2019. MATERIALS AND METHODS Data was collected from the GBD study 2019. Estimated annual percentage changes (EAPC) were used to quantify the trends of age-standardized death rate (ASDR). We applied a linear regression for the calculation of estimated annual percentage change in ASDR. RESULTS From 1990 to 2019, the ASDR of liver cancer decreased globally (EAPC = - 2.23, 95% confidence interval [CI]: - 2.61 to - 1.84). Meanwhile, declining trends were observed in both sexes, socio-demographic index (SDI) areas, and geographies, particularly East Asia (EAPC = - 4.98, 95% CI: - 5.73 to - 4.22). The ASDR for each of the four major etiologies fell globally, while liver cancer caused by hepatitis B had the largest drop (EPAC = - 3.46, 95% CI: - 4.01 to - 2.89). China has had dramatic decreases in death rates on a national scale, particularly when it comes to the hepatitis B etiology (EAPC = - 5.17, 95% CI: - 5.96 to - 4.37). However, certain nations, such as Armenia and Uzbekistan, saw a rise in liver cancer mortality. Controlling smoking, alcohol, and drug use contributed to a drop in LC-related mortality in the majority of socio-demographic index areas. Nevertheless, the excessive body mass index (BMI) was portrayed as the underlying cause for LC fatalities. CONCLUSION From 1990 to 2019, there was a worldwide decrease in deaths caused by liver cancer and its underlying causes. However, rising tendencies have been observed in low-resource regions and countries. The trends in drug use- and high BMI-related death from liver cancer and its underlying etiologies were concerning. The findings indicated that efforts should be increased to prevent liver cancer deaths through improved etiology control and risk management.
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Affiliation(s)
- Yongzhi Li
- Guangdong Provincial Key Laboratory of Tropical Disease Research, Department of Epidemiology, School of Public Health, Southern Medical University, 1838 Guangzhou North Road, Guangzhou, 510515, China
| | - Zejin Ou
- Key Laboratory of Occupational Environment and Health, Guangzhou Twelfth People's Hospital, Guangzhou, China
| | - Danfeng Yu
- Department of MICU, Guangdong Women and Children Hospital, Guangzhou, China
| | - Huan He
- Guangdong Provincial Key Laboratory of Tropical Disease Research, Department of Epidemiology, School of Public Health, Southern Medical University, 1838 Guangzhou North Road, Guangzhou, 510515, China
| | - Liting Zheng
- Guangdong Provincial Key Laboratory of Tropical Disease Research, Department of Epidemiology, School of Public Health, Southern Medical University, 1838 Guangzhou North Road, Guangzhou, 510515, China
| | - Jiaqi Chen
- Guangdong Provincial Key Laboratory of Tropical Disease Research, Department of Epidemiology, School of Public Health, Southern Medical University, 1838 Guangzhou North Road, Guangzhou, 510515, China
| | - Caiyun Chen
- Guangdong Provincial Key Laboratory of Tropical Disease Research, Department of Epidemiology, School of Public Health, Southern Medical University, 1838 Guangzhou North Road, Guangzhou, 510515, China
| | - Hushen Xiong
- Guangdong Provincial Key Laboratory of Tropical Disease Research, Department of Epidemiology, School of Public Health, Southern Medical University, 1838 Guangzhou North Road, Guangzhou, 510515, China
| | - Qing Chen
- Guangdong Provincial Key Laboratory of Tropical Disease Research, Department of Epidemiology, School of Public Health, Southern Medical University, 1838 Guangzhou North Road, Guangzhou, 510515, China.
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16
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Golabi P, Isakov V, Younossi ZM. Nonalcoholic Fatty Liver Disease: Disease Burden and Disease Awareness. Clin Liver Dis 2023; 27:173-186. [PMID: 37024201 DOI: 10.1016/j.cld.2023.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
Nonalcoholic fatty liver disease (NAFLD) has become the most common chronic liver disease worldwide and has been implying an unprecedented burden to health care systems. The prevalence of NAFLD has exceeded 30% in developed countries. Considering the asymptomatic nature of undiagnosed NAFLD, high suspicion and noninvasive diagnosis have utmost importance especially in primary care level. At this point, patient and provider awareness should be optimal for early diagnosis and risk stratification for patients at risk of progression.
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Affiliation(s)
- Pegah Golabi
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA; Department of Medicine, Center for Liver Disease, Inova Fairfax Medical Campus, 3300 Gallows Road, Falls Church, VA 2202, USA; Inova Medicine, Inova Health System, Falls Church, VA, USA
| | - Vasily Isakov
- Department of Gastroenterology & Hepatology, Federal Research Center for Nutrition and Biotechnology, 21 Kashirskoe Shosse, Moscow 115446, Russia
| | - Zobair M Younossi
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA; Department of Medicine, Center for Liver Disease, Inova Fairfax Medical Campus, 3300 Gallows Road, Falls Church, VA 2202, USA; Inova Medicine, Inova Health System, Falls Church, VA, USA; Inova Medicine Services, Department of Medicine, Inova Fairfax Medical Campus, Betty and Guy Beatty Center for Integrated Research, Claude Moore Health Education and Research Building, 3300 Gallows Road, Falls Church, VA 22042, USA.
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17
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Zhang X, Zhao L, Ducatman A, Deng C, von Stackelberg KE, Danford CJ, Zhang X. Association of per- and polyfluoroalkyl substance exposure with fatty liver disease risk in US adults. JHEP Rep 2023; 5:100694. [PMID: 36968216 PMCID: PMC10033989 DOI: 10.1016/j.jhepr.2023.100694] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 01/17/2023] [Indexed: 03/27/2023] Open
Abstract
Background & Aims Per- and polyfluoroalkyl substances (PFAS) are widespread pollutants with demonstrated hepatotoxicity. Few studies have examined the association between PFAS and fatty liver disease (FLD) risk in an adult population. Methods In this cross-sectional study of participants from the 2017-2018 National Health and Nutrition Examination Survey, serum PFAS were measured, and FLD cases were ascertained by vibration-controlled transient elastography. Logistic regression models were used to examine the association between circulating PFAS levels and FLD risk. Analyses were stratified into non-alcoholic FLD and alcoholic FLD risk groups by alcohol intake status, as well as controlling for other risk factors, including personal demographics, lifestyle factors, and related health factors. Results Among 1,135 eligible participants, 446 had FLD. For FLD risk, the multivariable-adjusted odds ratio per log-transformed SD increase (ORSD) in perfluorohexane sulfonate (PFHxS) was 1.13 (95% CI 1.01-1.26). The association between PFHxS and FLD appeared stronger among individuals with obesity or high-fat diets (both p interaction <0.05). When limiting the analysis to 212 heavy drinkers (≥2 drinks/day for women and ≥3 drinks/day for men), significantly higher risk of alcoholic FLD was found for higher levels of perfluorooctanoic acid (ORSD 1.79; 95% CI 1.07-2.99), PFHxS (ORSD 2.06; 95% CI 1.17-3.65), and perfluoroheptane sulfonic acid (ORSD 1.44; 95% CI 1.00-2.07), and marginally significant higher risk for total PFAS (ORSD 2.12; 95% CI 0.99-4.54). In never or light drinkers, we did not observe any significant association between PFAS and non-alcoholic FLD. Significant positive associations were found for PFAS with aspartate aminotransferase, gamma-glutamyl transaminase, total bilirubin, and albumin (β ranged from 0.008 to 0.101, all p <0.05). Conclusions Higher serum PFAS was moderately associated with FLD risk and worse liver function in the general population, and among those with independent risk factors, including heavy alcohol intake, obesity, or high-fat diets, PFAS increased the risk. These results suggest synergistic effects on hepatic steatosis between PFAS exposures as measured through biomonitoring data and lifestyle risk factors in a nationally representative US population. Impact and Implications The per- and polyfluoroalkyl substances (PFAS) may convey higher risk for chronic liver disease in humans. Among 1,135 US adults in the 2017-2018 National Health and Nutrition Examination Survey, we found that higher serum PFAS was associated with higher fatty liver disease risk and worse liver function, especially among those with liver disease risk factors, including heavy alcohol intake, obesity, or high-fat diets. Continuously monitoring PFAS in the population and examining how they potentiate risk to the liver are essential.
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Affiliation(s)
- Xinyuan Zhang
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Longgang Zhao
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Alan Ducatman
- Department of Occupational and Environmental Health Sciences, West Virginia University School of Public Health, Morgantown, WV, USA
| | - Chuanjie Deng
- Department of Epidemiology, University of California, Los Angeles, Los Angeles, CA, USA
| | | | | | - Xuehong Zhang
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
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18
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Bishop K, Balogun S, Eynstone-Hinkins J, Moran L, Martin M, Banks E, Rao C, Joshy G. Analysis of Multiple Causes of Death: A Review of Methods and Practices. Epidemiology 2023; 34:333-344. [PMID: 36719759 PMCID: PMC10069753 DOI: 10.1097/ede.0000000000001597] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 01/27/2023] [Indexed: 02/01/2023]
Abstract
BACKGROUND Research and reporting of mortality indicators typically focus on a single underlying cause of death selected from multiple causes recorded on a death certificate. The need to incorporate the multiple causes in mortality statistics-reflecting increasing multimorbidity and complex causation patterns-is recognized internationally. This review aims to identify and appraise relevant analytical methods and practices related to multiple causes. METHODS We searched Medline, PubMed, Scopus, and Web of Science from their incept ion to December 2020 without language restrictions, supplemented by consultation with international experts. Eligible articles analyzed multiple causes of death from death certificates. The process identified 4,080 items of which we reviewed 434 full-text articles. RESULTS Most articles we reviewed (76%, n = 332) were published since 2001. The majority of articles examined mortality by "any- mention" of the cause of death (87%, n = 377) and assessed pairwise combinations of causes (57%, n = 245). Since 2001, applications of methods emerged to group deaths based on common cause patterns using, for example, cluster analysis (2%, n = 9), and application of multiple-cause weights to re-evaluate mortality burden (1%, n = 5). We describe multiple-cause methods applied to specific research objectives for approaches emerging recently. CONCLUSION This review confirms rapidly increasing international interest in the analysis of multiple causes of death and provides the most comprehensive overview, to our knowledge, of methods and practices to date. Available multiple-cause methods are diverse but suit a range of research objectives. With greater availability of data and technology, these could be further developed and applied across a range of settings.
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Affiliation(s)
- Karen Bishop
- From the National Centre for Epidemiology and Population Health, Australian National University
| | - Saliu Balogun
- From the National Centre for Epidemiology and Population Health, Australian National University
| | | | - Lauren Moran
- Australian Bureau of Statistics, Canberra, Australia
| | - Melonie Martin
- From the National Centre for Epidemiology and Population Health, Australian National University
| | - Emily Banks
- From the National Centre for Epidemiology and Population Health, Australian National University
| | - Chalapati Rao
- From the National Centre for Epidemiology and Population Health, Australian National University
| | - Grace Joshy
- From the National Centre for Epidemiology and Population Health, Australian National University
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Paik JM, Eberly KE, Kabbara K, Harring M, Younossi Y, Henry L, Verma M, Younossi ZM. Non-alcoholic fatty liver disease is associated with greater risk of 30-day hospital readmission in the United States (U.S.). Ann Hepatol 2023; 28:101108. [PMID: 37088421 DOI: 10.1016/j.aohep.2023.101108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/30/2023] [Accepted: 04/14/2023] [Indexed: 04/25/2023]
Abstract
INTRODUCTION AND OBJECTIVES Data about 30-day readmission for patients with chronic liver disease (CLD) and their contribution to CLD healthcare burden are sparse. Patterns, diagnoses, timing and predictors of 30-day readmissions for CLD from 2010-2017 were assessed. MATERIALS AND METHODS Nationwide Readmission Database (NRD) is an all-payer, all-ages, longitudinal administrative database, representing 35 million discharges in the US population yearly. We identified unique patients discharged with CLD including hepatitis B (HBV) and C (HCV), alcoholic liver disease (ALD) and non-alcoholic fatty liver disease (NAFLD) from 2010 through 2017. Survey-weight adjusted multivariable were used. RESULTS From 2010 to 2017, the 30-day readmission rate for CLD decreased from 18.4% to 17.8% (p=.008), while increased for NAFLD from 17.0% to 19. 9% (p<.001). Of 125,019 patients discharged with CLD (mean age 57.4 years, male 59.0%) in 2017, the most common liver disease was HCV (29.2%), followed by ALD (23.5%), NAFLD (17.5%), and HBV (4.3%). Readmission rates were 20.5% for ALD, 19.9% for NAFLD, 16.8% for HCV and 16.7% for HBV. Compared to other liver diseases, patients with NAFLD had significantly higher risk of 30-day readmission in clinical comorbidities adjusted model (Hazard ratio [HR]=1.08 [95% confidence interval 1.03-1.13]). In addition to ascites, hepatic encephalopathy, higher number of coexisting comorbidities, comorbidities associated with higher risk of 30-day readmission included cirrhosis for NALFD and HCV; acute kidney injury for NAFLD, HCV and ALD; HCC for HCV, and peritonitis for ALD. Cirrhosis and cirrhosis-related complications was the most common reason for 30-day readmission, followed by sepsis. However, a large proportion of patients (43.7% for NAFLD; 28.4% for HCV, 39.0% for HBV, and 29.1% for ALD) were readmitted for extrahepatic reasons. Approximately 20% of those discharged with CLD were readmitted within 30 days but the majority of readmissions occurred within 15 days of discharge (62.8% for NAFLD, 63.7% for HCV, 74.3% for HBV, and 72.9% for ALD). Among readmitted patients, patients admitted ≤30-day had significantly higher cost and risk of in-hospital mortality for patients with NAFLD (+5.69% change [95% confidence interval, 2.54%-8.93%] and odds ratio (OR)=1.58 [1.28-1.95]) and HCV (+9.85% change [6.96%-12.82%] and OR=1.31, 1.08-1.59. CONCLUSIONS Early readmissions for CLD are prevalent causing economic and clinical burden to the US healthcare system, especially NAFLD readmissions. Closer surveillance and attention to both liver and extrahepatic medical conditions immediately after CLD discharge is encouraged.
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Affiliation(s)
- James M Paik
- Inova Medicine, Inova Health System, Falls Church, VA, United States; Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, United States
| | - Katherine E Eberly
- Inova Medicine, Inova Health System, Falls Church, VA, United States; Center for Liver Disease, Department of Medicine, Inova Fairfax Medical Campus, Falls Church, VA, United States
| | - Khaled Kabbara
- Inova Medicine, Inova Health System, Falls Church, VA, United States; Center for Liver Disease, Department of Medicine, Inova Fairfax Medical Campus, Falls Church, VA, United States
| | - Michael Harring
- Inova Medicine, Inova Health System, Falls Church, VA, United States; Center for Liver Disease, Department of Medicine, Inova Fairfax Medical Campus, Falls Church, VA, United States
| | - Youssef Younossi
- Center for Outcomes Research in Liver Diseases, Washington DC, United States; Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, United States
| | - Linda Henry
- Center for Outcomes Research in Liver Diseases, Washington DC, United States
| | - Manisha Verma
- Inova Medicine, Inova Health System, Falls Church, VA, United States; Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, United States
| | - Zobair M Younossi
- Inova Medicine, Inova Health System, Falls Church, VA, United States; Center for Liver Disease, Department of Medicine, Inova Fairfax Medical Campus, Falls Church, VA, United States; Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, United States.
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20
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Toh MR, Wong EYT, Wong SH, Ng AWT, Loo LH, Chow PKH, Ngeow JYY. Global Epidemiology and Genetics of Hepatocellular Carcinoma. Gastroenterology 2023; 164:766-782. [PMID: 36738977 DOI: 10.1053/j.gastro.2023.01.033] [Citation(s) in RCA: 97] [Impact Index Per Article: 97.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 01/27/2023] [Accepted: 01/29/2023] [Indexed: 02/06/2023]
Abstract
Hepatocellular carcinoma (HCC) is one of the leading cancers worldwide. Classically, HCC develops in genetically susceptible individuals who are exposed to risk factors, especially in the presence of liver cirrhosis. Significant temporal and geographic variations exist for HCC and its etiologies. Over time, the burden of HCC has shifted from the low-moderate to the high sociodemographic index regions, reflecting the transition from viral to nonviral causes. Geographically, the hepatitis viruses predominate as the causes of HCC in Asia and Africa. Although there are genetic conditions that confer increased risk for HCC, these diagnoses are rarely recognized outside North America and Europe. In this review, we will evaluate the epidemiologic trends and risk factors of HCC, and discuss the genetics of HCC, including monogenic diseases, single-nucleotide polymorphisms, gut microbiome, and somatic mutations.
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Affiliation(s)
- Ming Ren Toh
- Cancer Genetics Service, National Cancer Centre Singapore, Singapore
| | | | - Sunny Hei Wong
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Alvin Wei Tian Ng
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Lit-Hsin Loo
- Bioinformatics Institute, Agency for Science, Technology, and Research (A∗STAR), Singapore; Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Pierce Kah-Hoe Chow
- Department of Hepato-Pancreato-Biliary and Transplant Surgery, National Cancer Center Singapore and Singapore General Hospital, Singapore; Duke-NUS Medical School Singapore, Singapore
| | - Joanne Yuen Yie Ngeow
- Cancer Genetics Service, National Cancer Centre Singapore, Singapore; Division of Medical Oncology, National Cancer Centre Singapore, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Duke-NUS Medical School Singapore, Singapore.
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21
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Golabi P, Paik JM, Harring M, Younossi E, Kabbara K, Younossi ZM. Prevalence of High and Moderate Risk Nonalcoholic Fatty Liver Disease Among Adults in the United States, 1999-2016. Clin Gastroenterol Hepatol 2022; 20:2838-2847.e7. [PMID: 34929391 DOI: 10.1016/j.cgh.2021.12.015] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 12/08/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Nonalcoholic fatty liver disease (NAFLD) subjects with fibrosis stage ≥2 are at high risk for mortality. We aimed to provide national estimates and temporal trends for NAFLD, based on different fibrosis severity. METHODS Data from the National Health and Nutrition Examination Survey (NHANES) (1999-2016) and NHANES III (1988-1994) were utilized. NAFLD was determined by ultrasound showing moderate to severe steatosis. For those without ultrasound, NAFLD was determined by the U.S. Fatty Liver Index score of ≥30. Hepatic fibrosis was assessed using Fibrosis-4 (FIB-4) score (FIB-4 <1.3 = low risk; FIB-4 1.3-2.67 = moderate risk; and FIB-4 >2.67 = high risk). Annual percent change (APC) was calculated by using the joinpoint regression model. RESULTS From NHANES III, 10,854 individuals were included (mean age 43.5 years; 47.5% male; 75.7% non-Hispanic White) and 37.7% had NAFLD. Among them, based on FIB-4, 80% had low-risk, 18.6% had moderate-risk, and 1.4% had high-risk NAFLD. NAFLD with moderate or high risk was more likely to have hypertension, hyperlipidemia, diabetes, cardiovascular disease, and metabolic syndrome than was low-risk NAFLD (all P < .02). NAFLD prevalence increased from 29.5% in 1999-2000 to 40.3% in 2015-2016 (APC, 2.78%; P < .02), moderate-risk NAFLD increased from 6.26% to 14.17% (APC, 5.34%; P < .02), and high-risk NAFLD increased from 0.49% to 1.15% (APC, 9.72%; P < .02). Independent predictors of advanced fibrosis were age (OR, 1.11; 95% CI, 1.06-1.17; P = .001) and diabetes (OR, 2.28; 95% CI, 1.03-5.05; P = .04). Compared with low-risk NAFLD, high-risk NAFLD was associated with significantly increased all-cause (HR, 1.53; 95% CI, 1.09-2.15; P = .01), cardiovascular disease-specific (HR, 1.99; 95% CI, 1.22-3.24, P < .01) and liver-specific (HR, 4.57; 95% CI, 1.03-28.79; P = .04) mortality. CONCLUSIONS The prevalence of moderate- or high-risk NAFLD is increasing and is associated with increased all-cause, liver-related, and cardiovascular mortality.
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Affiliation(s)
- Pegah Golabi
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia; Center for Liver Disease, Department of Medicine, Inova Fairfax Medical Campus, Falls Church, Virginia
| | - James M Paik
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia; Center for Liver Disease, Department of Medicine, Inova Fairfax Medical Campus, Falls Church, Virginia
| | - Michael Harring
- Center for Liver Disease, Department of Medicine, Inova Fairfax Medical Campus, Falls Church, Virginia
| | - Elena Younossi
- Center for Outcomes Research in Liver Diseases, Washington, DC
| | - Khaled Kabbara
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia; Center for Liver Disease, Department of Medicine, Inova Fairfax Medical Campus, Falls Church, Virginia
| | - Zobair M Younossi
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia; Center for Liver Disease, Department of Medicine, Inova Fairfax Medical Campus, Falls Church, Virginia; Inova Medicine, Inova Health System, Falls Church, Virginia.
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22
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Henry L, Paik JM, Younossi ZM. Reply. Hepatology 2022; 76:E102-E103. [PMID: 35532942 DOI: 10.1002/hep.32565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 05/04/2022] [Indexed: 12/08/2022]
Affiliation(s)
- Linda Henry
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia, USA.,Center for Liver Disease, Department of Medicine, Inova Fairfax Medical Campus, Falls Church, Virginia, USA.,Inova Medicine, Inova Health System, Falls Church, Virginia, USA.,Center for Outcomes Research in Liver Diseases, Washington, District of Columbia, USA
| | - James M Paik
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia, USA.,Center for Liver Disease, Department of Medicine, Inova Fairfax Medical Campus, Falls Church, Virginia, USA.,Inova Medicine, Inova Health System, Falls Church, Virginia, USA
| | - Zobair M Younossi
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia, USA.,Center for Liver Disease, Department of Medicine, Inova Fairfax Medical Campus, Falls Church, Virginia, USA.,Inova Medicine, Inova Health System, Falls Church, Virginia, USA
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23
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Younossi ZM, Yilmaz Y, Yu ML, Wai-Sun Wong V, Fernandez MC, Isakov VA, Duseja AK, Mendez-Sanchez N, Eguchi Y, Bugianesi E, Burra P, George J, Fan JG, Papatheodoridis GV, Chan WK, Alswat K, Saeed HS, Singal AK, Romero-Gomez M, Gordon SC, Roberts SK, El Kassas M, Kugelmas M, Ong JP, Alqahtani S, Ziayee M, Lam B, Younossi I, Racila A, Henry L, Stepanova M. Clinical and Patient-Reported Outcomes From Patients With Nonalcoholic Fatty Liver Disease Across the World: Data From the Global Non-Alcoholic Steatohepatitis (NASH)/ Non-Alcoholic Fatty Liver Disease (NAFLD) Registry. Clin Gastroenterol Hepatol 2022; 20:2296-2306.e6. [PMID: 34768009 DOI: 10.1016/j.cgh.2021.11.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/21/2021] [Accepted: 11/01/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Globally, nonalcoholic fatty liver disease (NAFLD) is a common cause of chronic liver disease. We assessed the clinical presentation and patient-reported outcomes (PROs) among NAFLD patients from different countries. METHODS Clinical, laboratory, and PRO data (Chronic Liver Disease Questionnaire-nonalcoholic steatohepatitis [NASH], Functional Assessment of Chronic Illness Therapy-Fatigue, and the Work Productivity and Activity Index) were collected from NAFLD patients seen in real-world practices and enrolled in the Global NAFLD/NASH Registry encompassing 18 countries in 6 global burden of disease super-regions. RESULTS Across the global burden of disease super-regions, NAFLD patients (n = 5691) were oldest in Latin America and Eastern Europe and youngest in South Asia. Most men were enrolled at the Southeast and South Asia sites. Latin America and South Asia had the highest employment rates (>60%). Rates of cirrhosis varied (12%-21%), and were highest in North Africa/Middle East and Eastern Europe. Rates of metabolic syndrome components varied: 20% to 25% in South Asia and 60% to 80% in Eastern Europe. Chronic Liver Disease Questionnaire-NASH and Functional Assessment of Chronic Illness Therapy-Fatigue PRO scores were lower in NAFLD patients than general population norms (all P < .001). Across the super-regions, the lowest PRO scores were seen in Eastern Europe and North Africa/Middle East. In multivariate analysis adjusted for enrollment region, independent predictors of lower PRO scores included younger age, women, and nonhepatic comorbidities including fatigue (P < .01). Patients whose fatigue scores improved over time experienced a substantial PRO improvement. Nearly 8% of Global NAFLD/NASH Registry patients had a lean body mass index, with fewer metabolic syndrome components, fewer comorbidities, less cirrhosis, and significantly better PRO scores (P < .01). CONCLUSIONS NAFLD patients seen in real-world practices in different countries experience a high comorbidity burden and impaired quality of life. Future research using global data will enable more precise management and treatment strategies for these patients.
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Affiliation(s)
- Zobair M Younossi
- Center for Liver Disease, Department of Medicine, Inova Fairfax Medical Campus, Falls Church, Virginia; Medicine Service Line, Inova Health Sytem, Falls Church, Virginia.
| | - Yusuf Yilmaz
- Department of Gastroenterology, School of Medicine, Istanbul, Turkey; Liver Research Unit, Institute of Gastroenterology, Marmara University, Istanbul, Turkey
| | - Ming-Lung Yu
- Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan
| | - Vincent Wai-Sun Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | | | - Vasily A Isakov
- Federal Research Center of Nutrition, Biotechnology and Food Safety, Moscow, Russia
| | - Ajay K Duseja
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nahum Mendez-Sanchez
- Liver Research Unit, Medica Sur Clinic and Foundation, National Autonomous University of Mexico, Mexico City, Mexico
| | - Yuichiro Eguchi
- Locomedical General Institute, Locomedical Medical Cooperation, Ogi, Saga, Japan
| | - Elisabetta Bugianesi
- Division of Gastroenterology, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Patrizia Burra
- Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
| | - Jacob George
- Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital, University of Sydney, Australia
| | - Jian-Gao Fan
- Xinhua Hospital, Shanghai Jiatong University School of Medicine, Shanghai, China
| | | | - Wah Kheong Chan
- Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Khalid Alswat
- Liver Disease Research Center, Department of Medicine, College of Medicine, King Saud University, Saudi Arabia
| | - Hamid S Saeed
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Ashwani K Singal
- University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota
| | - Manuel Romero-Gomez
- Digestive Diseases Department, Virgen del Rocío University Hospital, Institute of Biomedicine of Seville, University of Seville, Spain
| | - Stuart C Gordon
- Henry Ford Hospital System, Department Gastroenterology and Hepatology, Wayne State University School of Medicine, Detroit, Michigan
| | - Stuart K Roberts
- The Alfred, Department of Hepatology and Gastroenterology, Monash University, Melbourne Victoria, Australia
| | - Mohamed El Kassas
- Endemic Medicine Department, Faculty of Medicine, Helwan University, Cairo, Egypt
| | | | - Janus P Ong
- University of the Philippines, College of Medicine, Manila, Philippines; Center for Outcomes Research in Liver Disease, Washington District of Columbia, Riyadh, Saudi Arabia
| | - Saleh Alqahtani
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia; Beatty Liver and Obesity Research Program, Inova Health System, Falls Church, Virginia
| | - Mariam Ziayee
- Center for Outcomes Research in Liver Disease, Washington District of Columbia, Riyadh, Saudi Arabia
| | - Brian Lam
- Center for Liver Disease, Department of Medicine, Inova Fairfax Medical Campus, Falls Church, Virginia; Medicine Service Line, Inova Health Sytem, Falls Church, Virginia; Beatty Liver and Obesity Research Program, Inova Health System, Falls Church, Virginia
| | - Issah Younossi
- Beatty Liver and Obesity Research Program, Inova Health System, Falls Church, Virginia
| | - Andrei Racila
- Center for Liver Disease, Department of Medicine, Inova Fairfax Medical Campus, Falls Church, Virginia; Medicine Service Line, Inova Health Sytem, Falls Church, Virginia; Beatty Liver and Obesity Research Program, Inova Health System, Falls Church, Virginia
| | - Linda Henry
- Center for Outcomes Research in Liver Disease, Washington District of Columbia, Riyadh, Saudi Arabia; Beatty Liver and Obesity Research Program, Inova Health System, Falls Church, Virginia
| | - Maria Stepanova
- Center for Outcomes Research in Liver Disease, Washington District of Columbia, Riyadh, Saudi Arabia; Beatty Liver and Obesity Research Program, Inova Health System, Falls Church, Virginia
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24
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Kim RG, Deng J, Reaso JN, Grenert JP, Khalili M. Noninvasive Fibrosis Screening in Fatty Liver Disease Among Vulnerable Populations: Impact of Diabetes and Obesity on FIB-4 Score Accuracy. Diabetes Care 2022; 45:2449-2451. [PMID: 35947698 PMCID: PMC9643136 DOI: 10.2337/dc22-0556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 07/08/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Fatty liver disease (FLD) is prevalent in diabetes, and both disproportionately affect vulnerable populations. The FIB-4 index is recommended to screen for advanced liver fibrosis. Limited data have suggested that diabetes may impact FIB-4. RESEARCH DESIGN AND METHODS We evaluated FIB-4 accuracy for advanced fibrosis compared with liver biopsy in the presence of diabetes and obesity. RESULTS Among 363 FLD patients receiving care in San Francisco's safety net health care system from August 2009 to February 2020, characteristics were as follows: median age 51 years, 46% male, 59% Hispanic, 68% obese, 33% with diabetes, and 31% with advanced fibrosis on histology. Overall, the c-statistic for FIB-4 was 0.79, but was worse in patients with diabetes, 0.68, than without, 0.85 (P = 0.003). Accuracy also varied by weight, at 0.65, 0.85, and 0.75 for normal weight, overweight, and obese, respectively, although not significantly (P = 0.24). CONCLUSIONS The findings highlight limitations of FIB-4 in screening for advanced liver fibrosis, particularly in individuals with diabetes.
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Affiliation(s)
- Rebecca G. Kim
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Jasmine Deng
- David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA
| | - Jewel N. Reaso
- Division of Gastroenterology and Hepatology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA
| | - James P. Grenert
- Division of Surgical Pathology, Department of Pathology and Laboratory Medicine, University of California, San Francisco, San Francisco, CA
- Liver Center, University of California San Francisco, San Francisco, CA
| | - Mandana Khalili
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California, San Francisco, San Francisco, CA
- Division of Gastroenterology and Hepatology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA
- Liver Center, University of California San Francisco, San Francisco, CA
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25
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Wu W, Feng A, Ma W, Li D, Zheng S, Xu F, Han D, Lyu J. Worldwide long-term trends in the incidence of nonalcoholic fatty liver disease during 1990–2019: A joinpoint and age-period-cohort analysis. Front Cardiovasc Med 2022; 9:891963. [PMID: 36172576 PMCID: PMC9510368 DOI: 10.3389/fcvm.2022.891963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 08/23/2022] [Indexed: 12/04/2022] Open
Abstract
Background Non-alcoholic fatty liver disease (NAFLD) was previously a neglected disease that is now becoming a worldwide pandemic. A better understanding of its incidence and long-term trends will help to increase public awareness of the disease and the development of future prevention strategies. Methods The incidence rates of NAFLD during 1990–2019 were collected from the Global Burden of Disease Study 2019 database according to the following parameters: sex, age, socio-demographic index, and geographical region. Estimated annual percentage changes and joinpoint models were used to assess the long-term trend of NAFLD, and an age-period-cohort model was used to assess the extents of the age, period, and cohort effects. Results Adult males, postmenopausal females, Latin American populations, and people in developing countries had a high risk of developing NAFLD. The joinpoint model indicated a new trend of increasing NAFLD incidence in 2005. Age was a risk factor affecting NAFLD incidence, with this effect increasing in more-recent periods. Younger birth cohorts had lower risks of NAFLD. Conclusions Recent prevention measures for NAFLD have achieved good initial results. However, it remains a high priority to increase the public awareness of this condition, develop its diagnostic criteria, identify cost-effective screening methods, and seek policy support to act against NAFLD, which will be a major public health problem in the future.
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Affiliation(s)
- Wentao Wu
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Aozi Feng
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Wen Ma
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Daning Li
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Shuai Zheng
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Fengshuo Xu
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Didi Han
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Jun Lyu
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China
- *Correspondence: Jun Lyu
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26
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Kim RG, Chu JN, Vittinghoff E, Deng J, Reaso JN, Grenert JP, Khalili M. Racial/ethnic differences in fibrosis prevalence and progression in biopsy-proven steatosis: A focus on the Asian American population. Hepatol Commun 2022; 6:3024-3035. [PMID: 36087033 PMCID: PMC9592793 DOI: 10.1002/hep4.2078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 06/10/2022] [Accepted: 08/01/2022] [Indexed: 12/14/2022] Open
Abstract
Fatty liver disease (FLD) is a leading cause of chronic liver disease (CLD) globally, and vulnerable populations are disproportionately affected. Prior studies have suggested racial/ethnic differences in FLD prevalence and severity; however, these studies often excluded Asian Americans. This study aims to evaluate racial/ethnic differences in the prevalence of, and predictors associated with steatohepatitis, advanced fibrosis, and fibrosis progression over time within a diverse population. Using descriptive analyses and multivariable modeling, we performed a longitudinal evaluation of 648 patients with histologic evidence of FLD (steatosis or steatohepatitis) from August 2009 to February 2020 within San Francisco's safety-net health care system. Overall demographics were median age of 53 years, 54% male, and 38% Asian (40% Hispanic, 14% White). On histology, 61% had steatohepatitis and 30% had advanced fibrosis (≥F3). The comparison between steatosis and steatohepatitis groups showed differences in sex, race/ethnicity, metabolic risk factors, and co-existing CLD (predominantly viral hepatitis); patients with steatosis were more likely to be Asian (50%), and those with steatohepatitis were more likely to be Hispanic (51%). On multivariable modeling, while Asian race (vs. non-Asian) was not associated with steatohepatitis or advanced fibrosis when models included all relevant clinical predictors, Asian race was associated with higher relative risk of fibrosis progression as defined by change in Fibrosis-4 category over time (relative risk ratio = 1.9; p = 0.047). Conclusion: In this vulnerable population with a large proportion of Asian Americans, Asian race was associated with progression of fibrosis. Given the relative paucity of data in this high-risk group, future studies should confirm these findings.
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Affiliation(s)
- Rebecca G. Kim
- Division of Gastroenterology and HepatologyDepartment of MedicineUniversity of California, San FranciscoSan FranciscoCaliforniaUSA,Division of Gastroenterology and HepatologyZuckerberg San Francisco GeneralSan FranciscoCaliforniaUSA
| | - Janet N. Chu
- Division of General Internal MedicineDepartment of MedicineUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Eric Vittinghoff
- Department of Epidemiology and BiostatisticsUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Jasmine Deng
- David Geffen School of Medicine at University of California, Los AngelesLos AngelesCaliforniaUSA
| | - Jewel N. Reaso
- Division of Gastroenterology and HepatologyZuckerberg San Francisco GeneralSan FranciscoCaliforniaUSA
| | - James P. Grenert
- Division of Surgical PathologyDepartment of Pathology and Laboratory MedicineUniversity of California, San FranciscoSan FranciscoCaliforniaUSA,Liver CenterUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Mandana Khalili
- Division of Gastroenterology and HepatologyDepartment of MedicineUniversity of California, San FranciscoSan FranciscoCaliforniaUSA,Division of Gastroenterology and HepatologyZuckerberg San Francisco GeneralSan FranciscoCaliforniaUSA,Liver CenterUniversity of California San FranciscoSan FranciscoCaliforniaUSA
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27
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Henry L, Paik J, Younossi ZM. Review article: the epidemiologic burden of non-alcoholic fatty liver disease across the world. Aliment Pharmacol Ther 2022; 56:942-956. [PMID: 35880713 DOI: 10.1111/apt.17158] [Citation(s) in RCA: 89] [Impact Index Per Article: 44.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/06/2022] [Accepted: 07/13/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND The prevalence of non-alcoholic fatty liver disease (NAFLD) is increasing in parallel with obesity and type 2 diabetes. AIM To review the global epidemiology of NAFLD METHODS: We retrieved articles from PubMed using search terms of NAFLD, epidemiology, prevalence, incidence, and comorbidities. RESULTS Over 250 articles were reviewed. In 2016, the global NAFLD prevalence was 25%; this increased to >30% in 2019. Prevalence in Asia, Latin America and Middle East-North Africa (MENA) was 30.8%, 34.5% and 42.6%, respectively. Prevalence increased with age. Although prevalence was higher in men, prevalence in post-menopausal women was similar. NAFLD prevalence was higher in certain subpopulations, especially among the obese and those with metabolic syndrome (MS). However, the prevalence of lean NAFLD was 11.2%. The global prevalence of non-alcoholic steatohepatitis (NASH) is estimated between 2% and 6% in the general population. Approximately 7% of patients with NAFLD have advanced fibrosis; rates were between 21% and 50% among patients with NASH. Overall mortality related to NAFLD was 15-20 per 1000 person-years, and increased substantially in patients with NASH, especially in those with components of MS. Recent data suggest mortality/morbidity from NAFLD is increasing globally but NAFLD awareness remains low among patients and healthcare providers. CONCLUSIONS NAFLD poses a global public health problem with a very high disease burden in Asia, MENA and Latin America. Research is needed to better quantify the full impact of NAFLD and to develop strategies to improve awareness and risk stratification.
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Affiliation(s)
- Linda Henry
- Center for Liver Diseases, Department of Medicine, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
| | - James Paik
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia, USA
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Wang XJ, Borah B, Rojas R, Kamath MJ, Moriarty J, Allen AM, Kamath PS. Patients Hospitalized for Complications of Cirrhosis may Have Benefited From Medicaid Expansion Under the Affordable Care Act. Mayo Clin Proc Innov Qual Outcomes 2022; 6:291-301. [PMID: 35722655 PMCID: PMC9198455 DOI: 10.1016/j.mayocpiqo.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective The benefit of the Affordable Care Act (ACA) for patients with cirrhosis is unclear. We determined the impact of ACA expansion on outcomes in patients hospitalized for complications of cirrhosis. Patients and Methods We compared hospitalizations; in-hospital outcomes; and readmissions among patients with cirrhosis identified using International Classification of Diseases, Ninth Revision, and International Classification of Diseases, 10th Revision, codes in states that expanded Medicaid under ACA (expanded [E] states) and those that did not (nonexpanded [NE] states). Data from the State Inpatient Databases were obtained for 3 pairs of contiguous E and NE states with both pre-ACA expansion and post-ACA expansion data. The difference-in-difference analysis was performed to compare the pre- and post-ACA data between the E and NE states. The outcomes were admission rates, hospital complications, resource utilization, length of stay, in-hospital mortality, discharge destination, cost of initial hospitalization, and readmission characteristics. Results There were 228,349 admissions (E states, 149,705; NE states, 78,644). After ACA implementation, the E states had lower rates of admission increase per 100,000 population (22.9 in E states vs 25.5 in NE states, P=.005), sepsis (relative risk, 0.884; P=.0084), and hepatic coma (relative risk, 0.763; P<.001) than the NE states. The length of stay was lower by 0.21 days (P=.00028), with a $587.40 lower cost per hospitalization (P=.00091), in the E states than in the NE states. The readmission rates within 30, 60, and 90 days decreased in the E states after ACA implementation but increased in the NE states after ACA implementation. Conclusion Among patients hospitalized for cirrhosis, quality indicators, such as the rate of admission increase, complications, costs, and readmissions, were more favorable in the states that expanded Medicaid. Medicaid expansion under ACA may have benefited patients with cirrhosis.
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Affiliation(s)
- Xiao Jing Wang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Bijan Borah
- Division of Health Care Policy and Research, Section of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Ricardo Rojas
- Division of Health Care Policy and Research, Section of Health Sciences Research, Mayo Clinic, Rochester, MN
| | | | - James Moriarty
- Division of Health Care Policy and Research, Section of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Alina M. Allen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Patrick S. Kamath
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
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Babekir A, Mostafa S, Minor RC, Williams LL, Harrison SH, Obeng-Gyasi E. The Association of Toxoplasma gondii IgG and Liver Injury in US Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:7515. [PMID: 35742764 PMCID: PMC9223808 DOI: 10.3390/ijerph19127515] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/17/2022] [Accepted: 06/17/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Toxoplasma gondii (T. gondii) is a ubiquitous obligatory intracellular parasite which infects over 40 million Americans and causes toxoplasmosis. Inside the human body, T. gondii can damage tissues and invade vital organs. METHODS This study evaluated the association of T. gondii infection and liver disease using data from the National Health and Nutrition Examination Survey (NHANES) 2009-2010, with a sample size of 3371 participants (age 20-80 years). Toxoplasma infection was determined by the level of T. gondii IgG antibody in serum samples. Liver disease was assessed by liver injury biomarkers and the Fatty Liver Index (US-FLI). The evaluation of the association between T. gondii infection and liver disease included the calculation of the Mantel-Haenszel risk ratio (RRMH), Rho-Scott chi-square bivariate analyses, design-based t-tests, and linear and logistic regression models which were adjusted for demographic and anthropometric covariates. RESULTS Mean levels of aspartate aminotransferase (AST) and alkaline phosphatase (ALP) were significantly more elevated in the T. gondii IgG-positive (IgG+) participants as compared to T. gondii-negative (IgG-) participants, p = 0.0435 and 0.0310, respectively. In linear regression analysis, exposure to T. gondii IgG+ had statistically significant positive associations with AST (p = 0.0211), alanine aminotransferase (ALT) (p = 0.0221), and gamma-glutamyl transferase (GGT) (p = 0.0258) after adjusting for BMI, age, gender, and race. T. gondii exposure was associated with an elevated relative risk of chronic liver disease (CLD) (RRMH = 1.26, 95% CI: 1.05-1.51). This association was more pronounced in certain occupations, such as construction, agriculture, forestry, and fishing, where Toxoplasma infection is more common (p = 0.0477). Moreover, Toxoplasma infection increased the odds of nonalcoholic fatty liver disease (NAFLD) (OR = 6.99, 95% CI = 1.85-26.32, p = 0.0237). CONCLUSION T. gondii IgG+ antibody was significantly associated with liver injury biomarkers (ALT, AST, GGT, and ALP) and an increased risk of CLD and NAFLD. Moreover, the association of Toxoplasma with CLD was more evident in specific occupations where the prevalence of Toxoplasma was high. The findings of this study provide insight into utilizing liver biomarkers and US-FLI to assess the health complications of Toxoplasma when imaging tests are not accessible.
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Affiliation(s)
- Amani Babekir
- Department of Built Environment, North Carolina A&T State University, Greensboro, NC 27411, USA;
- Environmental Health and Disease Laboratory, North Carolina A&T State University, Greensboro, NC 27411, USA
| | - Sayed Mostafa
- Department of Mathematics and Statistics, North Carolina A&T State University, Greensboro, 27411 NC, USA;
| | - Radiah C. Minor
- Department of Animal Sciences, North Carolina A&T State University, Greensboro, NC 27411, USA;
| | - Leonard L. Williams
- Center for Excellence in Post-Harvest Technologies, North Carolina A&T State University, Kannapolis, NC 28081, USA;
| | - Scott H. Harrison
- Department of Biology, North Carolina A&T State University, Greensboro, NC 27411, USA;
| | - Emmanuel Obeng-Gyasi
- Department of Built Environment, North Carolina A&T State University, Greensboro, NC 27411, USA;
- Environmental Health and Disease Laboratory, North Carolina A&T State University, Greensboro, NC 27411, USA
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Armstrong PR, Ring É, MacNicholas R. A decade of rising alcoholic liver disease hospital admissions and deaths in Irish hospitals, 2007-2016: a retrospective cross-sectional analysis. Eur J Gastroenterol Hepatol 2022; 34:671-677. [PMID: 34985049 DOI: 10.1097/meg.0000000000002339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Alcoholic liver disease (ALD) is a major cause of both liver cirrhosis and hepatocellular carcinoma (HCC) in Ireland. AIMS The aim of the study was to identify the epidemiological profile, temporal trends, development of complications and mortality arising from inpatient care episodes linked to ALD in Ireland from 2007 to 2016. METHODS This was a national retrospective study that analysed data on patient discharges from hospitals across Ireland. The Hospital Inpatient Enquiry System was used to gather this data. The main outcome measures were the number of hospital discharges for patients with ALD or HCC, also expressed per 100 000 population, the mortality rate associated with ALD and the prevalence of complications associated with ALD. RESULTS A total of 33 794 hospital discharges were examined. There was a 38% increase in hospital discharges and 300% increase in HCC coding for patients with ALD between 2006 and 2016. There were 73 hospital discharges with ALD per 100 000 population in 2016. That year, 40 482 bed days were required for inpatient management equating to 120 beds per day. Deaths from ALD rose by 29% over the 10-year period. Cirrhosis was diagnosed in 57% and 24% had ascites. Mortality was 9.8% rising to 16% with variceal bleeding and 42% with acute kidney injury. Only 31% were under the care of a gastroenterologist or hepatologist. CONCLUSION Ireland is seeing a rise in ALD-related hospital admissions and deaths, including HCC which increased three-fold. ALD is a preventable disease, and public health interventions are of proven benefit and required to reverse this trend.
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Affiliation(s)
- Paul R Armstrong
- Department of Hepatology, The National Liver Transplant Unit, St. Vincent's University Hospital, Dublin, Ireland
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Prevalence of Pruritus and Association with Anxiety and Depression in Patients with Nonalcoholic Fatty Liver Disease. Biomedicines 2022; 10:biomedicines10020451. [PMID: 35203659 PMCID: PMC8962437 DOI: 10.3390/biomedicines10020451] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 02/10/2022] [Accepted: 02/12/2022] [Indexed: 11/17/2022] Open
Abstract
Patient-reported outcomes are important in nonalcoholic fatty liver disease (NAFLD). Pruritus is of special interest for evolving therapies with farnesoid X receptor (FXR) agonists. The aim of this study was to investigate the prevalence of pruritus in a real-life NAFLD cohort and analyze associations with anxiety and depression. Pruritus was assessed using a visual analogue- (VAS) and 5-D itch-scale (5-D). Anxiety and depression were evaluated by Beck’s-Depression-Inventory (BDI) and the Hospital Anxiety and Depression Scale (HADS-A, HADS-D). An optimal logistic regression model was found with a stepwise procedure to investigate variables associated with pruritus. In total, 123 NAFLD patients were recruited. VAS and 5-D were highly correlated (Spearman’s correlation coefficient 0.89). Moderate/severe pruritus was reported in 19% (VAS) and 21% (5-D) of patients. Anxiety and depression were present in 12% and 4% (HADS-A and HADS-D, respectively) and 12% (BDI) of cases. There was a significant association between VAS and BDI (p = 0.019). The final multivariate model for 5-D included diabetes mellitus (OR 4.51; p = 0.01), BDI (OR 5.98; p = 0.024), and HADS-A (OR 7.75; p = 0.011). One-fifth of NAFLD patients reported moderate or severe pruritus. 5-D was significantly associated with diabetes mellitus, depression, and anxiety. These findings should be tested in larger populations and considered in candidates for treatment with FXR agonists.
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Sebastiani G, Patel K, Ratziu V, Feld JJ, Neuschwander-Tetri BA, Pinzani M, Petta S, Berzigotti A, Metrakos P, Shoukry N, Brunt EM, Tang A, Cobbold JF, Ekoe JM, Seto K, Ghali P, Chevalier S, Anstee QM, Watson H, Bajaj H, Stone J, Swain MG, Ramji A. Current considerations for clinical management and care of non-alcoholic fatty liver disease: Insights from the 1st International Workshop of the Canadian NASH Network (CanNASH). CANADIAN LIVER JOURNAL 2022; 5:61-90. [PMID: 35990786 PMCID: PMC9231423 DOI: 10.3138/canlivj-2021-0030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 09/07/2021] [Indexed: 08/30/2023]
Abstract
Non-alcoholic fatty liver disease (NAFLD) affects approximately 8 million Canadians. NAFLD refers to a disease spectrum ranging from bland steatosis to non-alcoholic steatohepatitis (NASH). Nearly 25% of patients with NAFLD develop NASH, which can progress to liver cirrhosis and related end-stage complications. Type 2 diabetes and obesity represent the main risk factors for the disease. The Canadian NASH Network is a national collaborative organization of health care professionals and researchers with a primary interest in enhancing understanding, care, education, and research around NAFLD, with a vision of best practices for this disease state. At the 1st International Workshop of the CanNASH network in April 2021, a joint event with the single topic conference of the Canadian Association for the Study of the Liver (CASL), clinicians, epidemiologists, basic scientists, and community members came together to share their work under the theme of NASH. This symposium also marked the initiation of collaborations between Canadian and other key opinion leaders in the field representative of international liver associations. The main objective is to develop a policy framework that outlines specific targets, suggested activities, and evidence-based best practices to guide provincial, territorial, and federal organizations in developing multidisciplinary models of care and strategies to address this epidemic.
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Affiliation(s)
- Giada Sebastiani
- Division of Gastroenterology and Hepatology, Royal Victoria Hospital, McGill University Health Centre, Montréal, Québec, Canada
| | - Keyur Patel
- Toronto Centre for Liver Disease, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Vlad Ratziu
- Assistance Publique-Hôpitaux de Paris, Hôpital Pitié Salpêtrière, Sorbonne University, Paris, France
| | - Jordan J Feld
- Toronto Centre for Liver Disease, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | - Massimo Pinzani
- UCL Institute for Liver and Digestive Health, Division of Medicine - Royal Free Hospital, London, UK
| | - Salvatore Petta
- Section of Gastroenterology and Hepatology, PROMISE, Università di Palermo, Palermo, Italy
| | - Annalisa Berzigotti
- Hepatology, University Clinic for Visceral Surgery and Medicine, Inselspital, University Hospital of Bern, University of Bern, Switzerland
| | - Peter Metrakos
- Cancer Research Program, McGill University Health Centre Research Institute, Montréal, Québec, Canada
| | - Naglaa Shoukry
- Centre de Recherche du Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | | | - An Tang
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Québec, Canada
| | - Jeremy F Cobbold
- Department of Gastroenterology, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Jean-Marie Ekoe
- Montreal Institute for Clinical Research, Division of Endocrinology and Department of Nutrition, Université de Montréal, Montréal, Québec, Canada
| | - Karen Seto
- Canadian Liver Foundation, Markham, Ontario, Canada
| | - Peter Ghali
- University of Florida, Gainesville, Florida, USA
| | | | - Quentin M Anstee
- Translational & Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | | | - Harpreet Bajaj
- LMC Diabetes and Endocrinology, Brampton, Ontario, Canada
| | - James Stone
- Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Mark G Swain
- Calgary Liver Unit, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Alnoor Ramji
- Division of Gastroenterology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Ryu E, Xia HH, Guo GL, Zhang L. Multivariable-adjusted trends in mortality due to alcoholic liver disease among adults in the United States, from 1999-2017. Am J Transl Res 2022; 14:1092-1099. [PMID: 35273712 PMCID: PMC8902556 DOI: pmid/35273712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 01/17/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Mortality-trends from alcoholic liver disease (ALD) have recently increased and they differ by various factors in the U.S. However, these trends have only been analyzed using univariate models and in reality they may be influenced by various factors. We thus examined trends in age-standardized mortality from ALD among U.S. adults for 1999-2017, using multivariable piecewise log-linear models. METHODS We collected mortality-data from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research database, using the Underlying Cause of Death. RESULTS We identified 296,194 deaths from ALD and 346,386 deaths indirectly attributable to ALD during the period from 1999-2017. The multivariable-adjusted, age-standardized ALD mortality was stable during 1999-2006 (annual percentage change [APC]=-2.24, P=0.24), and increased during 2006-2017 (APC=3.18, P<0.006). Their trends did not differ by sex, race, age or urbanization. Subgroup analyses revealed upward multivariable-adjusted, age-standardized mortality-trends in alcoholic fatty liver (APC=4.64, P<0.001), alcoholic hepatitis (APC=4.38, P<0.001), and alcoholic cirrhosis (APC=5.33, P<0.001), but downward mortality-trends in alcoholic hepatic failure (APC=-1.63, P=0.006) and unspecified ALD (APC=-0.86, P=0.013). Strikingly, non-alcoholic cirrhosis also had an upward multivariable-adjusted, age-standardized mortality-trend (APC=0.69, P=0.046). By contrast, recent mortality-trends were stable for all cause of deaths (APC=-0.39, P=0.379) and downward for malignant neoplasms excluding liver cancer (APC=-2.82, P<0.001), infections (APC=-2.60, P<0.001), cardiovascular disease (APC=-0.69, P=0.044) and respiratory disease (APC=-0.56, P=0.002). The adjusted mortality with ALD as a contributing cause of death also had an upward trend during 2000-2017 (APC=5.47, P<0.001). Strikingly, common comorbidities of ALD, including hepatocellular carcinoma, cerebrovascular and ischemic heart cardiovascular diseases and sepsis, had upward trends during the past 14 to 16 years. CONCLUSIONS ALD had an upward multivariable-adjusted, age-standardized mortality-trend among U.S. adults, without significant differences by sex, race, age or urbanization. Three ALD subtypes (alcoholic fatty liver, alcoholic hepatitis and alcoholic cirrhosis) and non-alcoholic cirrhosis had upward morality-trends, while other ALD subtypes and other causes of death did not.
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Affiliation(s)
- Emily Ryu
- Department of Chemistry, Princeton UniversityPrinceton, NJ 08544, USA
| | - Harry H Xia
- Department of Gastroenterology, First Affiliated Hospital, Guangdong Pharmaceutical UniversityGuangzhou 510000, Guangdong, China
| | - Grace L Guo
- Department of Pharmacology and Toxicology, Ernest Mario School of Pharmacy, Rutgers UniversityPiscataway, NJ 08854, USA
- Environmental and Occupational Health Sciences Institute, Rutgers, State University of New JerseyPiscataway, NJ 08854, USA
| | - Lanjing Zhang
- Department of Pathology, Princeton Medical CenterPlainsboro, NJ 08563, USA
- Department of Biological Sciences, Rutgers University NewarkNJ 07102, USA
- Department of Chemical Biology, Ernest Mario School of Pharmacy, Rutgers UniversityPiscataway, NJ 08854, USA
- Rutgers Cancer Institute of New JerseyNew Brunswick, NJ 08901, USA
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Gonzalez-Chagolla A, Olivas-Martinez A, Ruiz-Manriquez J, Servín-Rojas M, Kauffman-Ortega E, Chávez-García LC, Juárez-León O, Cordova-Gallardo J, Díaz-García JD, Gonzalez-Huezo MS, Milanés-Lizarraga G, Paez-Zayas VM, Castillo-Barradas M, Cobos-Quevedo ODJ, García-Juárez FI, Romero-Lozanía JA, Toapanta-Yanchapaxi L, Sánchez-Avila JF, Avila-Rojo JA, Bonilla-Salas A, Dirthurbide-Hernández M, Ruiz I, Valenzuela-Vidales AK, García-Juárez I. Cirrhosis etiology trends in developing countries: Transition from infectious to metabolic conditions. Report from a multicentric cohort in central Mexico. LANCET REGIONAL HEALTH. AMERICAS 2021; 7:100151. [PMID: 36777654 PMCID: PMC9904121 DOI: 10.1016/j.lana.2021.100151] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Background Cirrhosis is a public health threat associated with high mortality. Alcoholic Liver Disease (ALD) is the leading cause in Latin America and Metabolic Associated Fatty Liver Disease (MAFLD) in western countries. In Mexico, ALD and chronic Hepatitis C Virus infection (HCV) were the most frequent aetiologies during the past decades. We aimed to describe the trends in the aetiologies of cirrhosis in a middle-income country. Methods We performed a retrospective cohort study including patients diagnosed with cirrhosis between 2000 and 2019 from six different tertiary care hospitals in central Mexico. We collected information regarding cirrhosis etiology, year of diagnosis, hepatocellular carcinoma development, liver transplantation, and death. We illustrated the change in the tendencies of cirrhosis aetiologies by displaying the proportional incidence of each etiology over time stratified by age and gender, and we compared these proportions over time using chi square tests. Findings Overall, 4,584 patients were included. In 2019, MAFLD was the most frequent cirrhosis etiology (30%), followed by ALD (24%) and HCV (23%). During the study period, MAFLD became the leading etiology, ALD remained second, and HCV passed from first to fourth. When analysed by gender, ALD was the leading etiology for men and MAFLD for women. The annual incidence of HCC was 3·84 cases/100 persons-year, the median survival after diagnosis was 12·1 years, and seven percent underwent LT. Interpretation Increased alcohol consumption and the obesity epidemic have caused a transition in the aetiologies of cirrhosis in Mexico. Public health policies must be tailored accordingly to mitigate the burden of alcohol and metabolic conditions in developing countries. Funding None.
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Affiliation(s)
- Alex Gonzalez-Chagolla
- Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - Jesus Ruiz-Manriquez
- Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Maximiliano Servín-Rojas
- Liver transplant unit and department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Av. Vasco de Quiroga 15, colonia Belisario Domínguez Sección XVI, Tlalpan, Mexico City 14080, Mexico
| | - Eric Kauffman-Ortega
- Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Luis Carlos Chávez-García
- Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Oscar Juárez-León
- Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - Juan Daniel Díaz-García
- Department of Internal Medicine, Hospital General Dr Manuel Gea Gonzalez,Mexico City, Mexico
| | | | | | - Victor M Paez-Zayas
- Organ Transplant Department, Hospital General de Mexico Doctor Eduardo Liceaga, Mexico City, Mexico
| | - Mauricio Castillo-Barradas
- Department of Gastroenterology, Hospital de Especialidades Dr Antonio Fraga Mouret Centro Médico Nacional La Raza IMSS, Mexico City, Mexico
| | - Orestes de Jesús Cobos-Quevedo
- Department of Gastroenterology, Hospital de Especialidades Dr Antonio Fraga Mouret Centro Médico Nacional La Raza IMSS, Mexico City, Mexico
| | | | | | - Liz Toapanta-Yanchapaxi
- Neuromuscular Disease Clinic, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - José Alonso Avila-Rojo
- Department of Internal Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Aliberth Bonilla-Salas
- Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - Isaac Ruiz
- Department of Hepatology and Liver Transplantation, Centre Hospitalier de l'Université de Montréal (CHUM), Canada,Institut Mondor de Recherche Biomédicale (IMRB), INSERM U955 Team 18, Hôpital Henri Mondor, Université Paris-Est, Créteil, France
| | - Ana K. Valenzuela-Vidales
- Department of Hematology-Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Ignacio García-Juárez
- Liver transplant unit and department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Av. Vasco de Quiroga 15, colonia Belisario Domínguez Sección XVI, Tlalpan, Mexico City 14080, Mexico,Corresponding author.
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Fatty Liver through the Ages- Non-Alcoholic Steatohepatitis (NASH). Endocr Pract 2021; 28:204-213. [PMID: 34952219 DOI: 10.1016/j.eprac.2021.12.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 12/13/2021] [Accepted: 12/13/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND The global epidemic of obesity and type 2 diabetes mellitus is the main driver of the growing global prevalence of non-alcoholic fatty liver disease (NAFLD). We aimed to review the current literature on NAFLD and NASH as it impacts children and adults. METHODS We performed a literature search on fatty liver specifically non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) among children and adults. RESULTS The prevalence of NAFLD in children ranges from 8%-12% while the prevalence in adults ranges 25%-48%. The prevalence of NASH among children with NAFLD is 23% while it ranges from 13% to 65% in the adults. There are similar risk factors for NAFLD among children and adults. However, in children, the diagnostic tests in the studies of NAFLD are limited to elevation of ALT level or a liver biopsy. In adults, additional diagnostic modalities, including non-invasive tests (NITs), have been used. From the spectrum of NAFLD, those with NASH are predominantly at risk of progressive liver disease to cirrhosis and liver-related mortality. NAFLD is associated with impairment of health-related quality of life and substantial economic burden. CONCLUSION The comprehensive burden (clinical, HRQL and economic) of NAFLD is high and increasing.
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von Loeffelholz C, Roth J, Coldewey SM, Birkenfeld AL. The Role of Physical Activity in Nonalcoholic and Metabolic Dysfunction Associated Fatty Liver Disease. Biomedicines 2021; 9:biomedicines9121853. [PMID: 34944668 PMCID: PMC8698784 DOI: 10.3390/biomedicines9121853] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 12/01/2021] [Accepted: 12/02/2021] [Indexed: 12/17/2022] Open
Abstract
Sedentary behavior constitutes a pandemic health threat contributing to the pathophysiology of obesity and type 2 diabetes (T2D). Sedentarism is further associated with liver disease and particularly with nonalcoholic/metabolic dysfunction associated fatty liver disease (NAFLD/MAFLD). Insulin resistance (IR) represents an early pathophysiologic key element of NAFLD/MAFLD, prediabetes and T2D. Current treatment guidelines recommend regular physical activity. There is evidence, that physical exercise has impact on a variety of molecular pathways, such as AMP-activated protein kinase and insulin signaling as well as glucose transporter 4 translocation, modulating insulin action, cellular substrate flow and in particular ectopic lipid and glycogen storage in a positive manner. Therefore, physical exercise can lead to substantial clinical benefit in persons with diabetes and/or NAFLD/MAFLD. However, experience from long term observational studies shows that the patients’ motivation to exercise regularly appears to be a major limitation. Strategies to integrate everyday physical activity (i.e., nonexercise activity thermogenesis) in lifestyle treatment schedules might be a promising approach. This review aggregates evidence on the impact of regular physical activity on selected molecular mechanisms as well as clinical outcomes of patients suffering from IR and NAFLD/MAFLD.
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Affiliation(s)
- Christian von Loeffelholz
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, 07747 Jena, Germany; (J.R.); (S.M.C.)
- Correspondence: ; Tel.: +49-3641-9323-177; Fax: +49-3641-9323-102
| | - Johannes Roth
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, 07747 Jena, Germany; (J.R.); (S.M.C.)
| | - Sina M. Coldewey
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, 07747 Jena, Germany; (J.R.); (S.M.C.)
- Septomics Research Center, Jena University Hospital, 07747 Jena, Germany
- Center for Sepsis Control and Care, Jena University Hospital, 07747 Jena, Germany
| | - Andreas L. Birkenfeld
- Department of Diabetology Endocrinology and Nephrology, Internal Medicine IV, University Hospital Tübingen, Eberhard Karls University Tübingen, 72074 Tübingen, Germany;
- Division of Translational Diabetology, Institute of Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich, Eberhard Karls University Tübingen, 72074 Tübingen, Germany
- Department of Diabetes, School of Life Course Science and Medicine, Kings College London, London WC2R 2LS, UK
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Younossi ZM, Stepanova M, Lam B, Cable R, Felix S, Jeffers T, Younossi E, Pham H, Srishord M, Austin P, Estep M, Terra K, Escheik C, de Avila L, Golabi P, Kolacevski A, Racila A, Henry L, Gerber L. Independent Predictors of Mortality Among Patients With NAFLD Hospitalized With COVID-19 Infection. Hepatol Commun 2021; 6:3062-3072. [PMID: 34558853 PMCID: PMC8426701 DOI: 10.1002/hep4.1802] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The impact of the coronavirus disease 2019 (COVID-19) pandemic among patients with chronic liver disease is unknown. Given the high prevalence of nonalcoholic fatty liver disease (NAFLD), we determined the predictors of mortality and hospital resource use among patients with NAFLD admitted with COVID-19 by using electronic medical records data for adult patients with COVID-19 hospitalized in a multihospital health system who were discharged between March and December 2020. NAFLD was diagnosed by imaging or liver biopsy without other liver diseases. Charlson's comorbidity index (CCI) and Elixhauser comorbidity index (ECI) scores were calculated. In the study sample, among the 4,835 patients hospitalized for COVID-19, 553 had NAFLD (age: 55 ± 16 years, 51% male, 17% White, 11% Black, 58% Hispanic, 8% Asian, 5% from congregated living, 58% obese, 15% morbid obesity [body mass index ≥ 40], 51% type 2 diabetes, 63% hypertension, mean [SD] baseline CCI of 3.9 [3.2], and baseline ECI of 13.4 [11.3]). On admission, patients with NAFLD had more respiratory symptoms, higher body temperature and heart rate, higher alanine aminotransferase and aspartate aminotransferase than non-NAFLD controls (n = 2,736; P < 0.05). Of the patients with NAFLD infected with COVID-19, 3.9% experienced acute liver injury. The NAFLD group had significantly longer length of stay, intensive care unit use, and mechanical ventilation, with a crude inpatient mortality rate of 11%. In multivariate analysis, independent predictors of inpatient mortality among patients with NAFLD infected with COVID-19 were older age, morbid obesity, ECI score ≥ 11, higher Fibrosis-4 Index (FIB-4) score, and oxygen saturation <90% (all P < 0.05), but not sex, race/ethnicity, or any individual comorbidity (all P > 0.05). Conclusion: Patients with NAFLD infected with COVID-19 tend to be sicker on admission and require more hospital resource use. Independent predictors of mortality included higher FIB-4 and multimorbidity scores, morbid obesity, older age, and hypoxemia on admission.
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Affiliation(s)
- Zobair M. Younossi
- Inova MedicineInova Health SystemFalls ChurchVAUSA,Betty and Guy Beatty Center for Integrated ResearchInova Health SystemFalls ChurchVAUSA
| | - Maria Stepanova
- Inova MedicineInova Health SystemFalls ChurchVAUSA,Betty and Guy Beatty Center for Integrated ResearchInova Health SystemFalls ChurchVAUSA
| | - Brian Lam
- Inova MedicineInova Health SystemFalls ChurchVAUSA,Betty and Guy Beatty Center for Integrated ResearchInova Health SystemFalls ChurchVAUSA
| | - Rebecca Cable
- Inova MedicineInova Health SystemFalls ChurchVAUSA,Betty and Guy Beatty Center for Integrated ResearchInova Health SystemFalls ChurchVAUSA
| | - Sean Felix
- Inova MedicineInova Health SystemFalls ChurchVAUSA,Betty and Guy Beatty Center for Integrated ResearchInova Health SystemFalls ChurchVAUSA
| | - Thomas Jeffers
- Inova MedicineInova Health SystemFalls ChurchVAUSA,Betty and Guy Beatty Center for Integrated ResearchInova Health SystemFalls ChurchVAUSA
| | - Elena Younossi
- Inova MedicineInova Health SystemFalls ChurchVAUSA,Betty and Guy Beatty Center for Integrated ResearchInova Health SystemFalls ChurchVAUSA
| | - Huong Pham
- Inova MedicineInova Health SystemFalls ChurchVAUSA,Betty and Guy Beatty Center for Integrated ResearchInova Health SystemFalls ChurchVAUSA
| | - Manirath Srishord
- Inova MedicineInova Health SystemFalls ChurchVAUSA,Betty and Guy Beatty Center for Integrated ResearchInova Health SystemFalls ChurchVAUSA
| | - Patrick Austin
- Inova MedicineInova Health SystemFalls ChurchVAUSA,Betty and Guy Beatty Center for Integrated ResearchInova Health SystemFalls ChurchVAUSA
| | - Michael Estep
- Inova MedicineInova Health SystemFalls ChurchVAUSA,Betty and Guy Beatty Center for Integrated ResearchInova Health SystemFalls ChurchVAUSA
| | - Kathy Terra
- Inova MedicineInova Health SystemFalls ChurchVAUSA,Betty and Guy Beatty Center for Integrated ResearchInova Health SystemFalls ChurchVAUSA
| | - Carey Escheik
- Inova MedicineInova Health SystemFalls ChurchVAUSA,Betty and Guy Beatty Center for Integrated ResearchInova Health SystemFalls ChurchVAUSA
| | - Leyla de Avila
- Inova MedicineInova Health SystemFalls ChurchVAUSA,Betty and Guy Beatty Center for Integrated ResearchInova Health SystemFalls ChurchVAUSA
| | - Pegah Golabi
- Inova MedicineInova Health SystemFalls ChurchVAUSA,Betty and Guy Beatty Center for Integrated ResearchInova Health SystemFalls ChurchVAUSA
| | - Andrej Kolacevski
- Inova MedicineInova Health SystemFalls ChurchVAUSA,Betty and Guy Beatty Center for Integrated ResearchInova Health SystemFalls ChurchVAUSA
| | - Andrei Racila
- Inova MedicineInova Health SystemFalls ChurchVAUSA,Betty and Guy Beatty Center for Integrated ResearchInova Health SystemFalls ChurchVAUSA
| | - Linda Henry
- Inova MedicineInova Health SystemFalls ChurchVAUSA,Betty and Guy Beatty Center for Integrated ResearchInova Health SystemFalls ChurchVAUSA
| | - Lynn Gerber
- Inova MedicineInova Health SystemFalls ChurchVAUSA,Betty and Guy Beatty Center for Integrated ResearchInova Health SystemFalls ChurchVAUSA
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38
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Paik JM, Golabi P, Younossi Y, Saleh N, Nhyira A, Younossi ZM. The Growing Burden of Disability Related to Chronic Liver Disease in the United States: Data From the Global Burden of Disease Study 2007-2017. Hepatol Commun 2021; 5:749-759. [PMID: 34027266 PMCID: PMC8122384 DOI: 10.1002/hep4.1673] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/25/2020] [Accepted: 12/09/2020] [Indexed: 12/17/2022] Open
Abstract
Chronic liver disease (CLD) causes significant morbidity and mortality in the United States with regional variations. Comparable and consistent state-level measures of CLD-related morbidity and disability among U.S. states have not been well studied. Our aim was to assess the CLD burden within the United States between 2007 and 2017 based on the most common causes of CLD: hepatitis B virus, hepatitis C virus (HCV), alcoholic liver disease (ALD), and nonalcoholic fatty liver disease (NAFLD). The Global Burden of Disease database was used for the years 2007-2017. International Classification of Diseases, Tenth Revision, codes were used to identify liver cancer (LC) and cirrhosis. Disability-adjusted life years (DALYs) were computed by the summation of years of life lost and years lived with disability. All rates reported here were age-standardized rates per 100,000 population. In 2017, there were 167,324 incident CLDs, 21% from LC and 79% from cirrhosis; this number was 30% higher than in 2007. The highest rate increases were seen in Kentucky, New York, and Pennsylvania. In 2017, there were 90,046 CLD-related deaths, which was 34% higher than in 2007. Highest rank increases were seen in Kentucky, Montana, and Washington. The rate of CLD incidence and death due to NAFLD was higher than other causes of CLD. In 2017, CLD caused 2.33 million DALYs, which was 27% higher than in 2007 and was mainly driven by HCV (37.2%), ALD (27.7%), and NAFLD (10.6%). California, Texas, and Florida had the highest DALYs; however, the highest CLD-DALY rates per 100,000 population were seen in New Mexico, District of Columbia, and Oklahoma. Conclusion: The CLD-related burden is increasing in the majority of U.S. states at an unprecedented rate. The impact of this burden on individual states is heterogeneous, and there are important disparities among states that merit further investigation.
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Affiliation(s)
- James M. Paik
- Betty and Guy Beatty Center for Integrated ResearchInova Health SystemFalls ChurchVAUSA
| | - Pegah Golabi
- Betty and Guy Beatty Center for Integrated ResearchInova Health SystemFalls ChurchVAUSA
| | | | - Nazaneen Saleh
- Betty and Guy Beatty Center for Integrated ResearchInova Health SystemFalls ChurchVAUSA
| | - Annan Nhyira
- Betty and Guy Beatty Center for Integrated ResearchInova Health SystemFalls ChurchVAUSA
| | - Zobair M. Younossi
- Betty and Guy Beatty Center for Integrated ResearchInova Health SystemFalls ChurchVAUSA
- Center for Liver DiseaseDepartment of MedicineInova Fairfax Medical CampusFalls ChurchVAUSA
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Abstract
PURPOSE OF REVIEW Nonalcoholic fatty liver disease (NAFLD) and type 2 diabetes mellitus (T2DM) are strongly associated. Both also associate with an increased risk of cardiovascular disease (CVD). RECENT FINDINGS Several studies have provided evidence that NAFLD could be an independent CVD risk factor. Given the strong association between NAFLD and T2DM, assessing the independent CV effect of these two conditions remains challenging. However, patients with T2DM and NAFLD exhibit higher risk of CVD compared with T2DM without NAFLD suggesting a potential synergistic increase of CV risk in patients with both T2DM and NAFLD supported by several shared pathophysiological pathways. Several anti-diabetic therapies have shown beneficial effect on both NAFLD and CVD. Patients with T2DM and NAFLD should be considered at high risk of CVD and could benefit from more intensive CV prevention. Additional long-term follow-up is needed to demonstrate that the treatment of NAFLD effectively reduces the risk of CVD.
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Affiliation(s)
- Cyrielle Caussy
- Hôpital Lyon Sud, Département Endocrinologie, Diabète et Nutrition, Hospices Civils de Lyon, 69495, Pierre-Bénite, France.
| | - Adrien Aubin
- Hôpital Lyon Sud, Département Endocrinologie, Diabète et Nutrition, Hospices Civils de Lyon, 69495, Pierre-Bénite, France
| | - Rohit Loomba
- Department of Medicine, NAFLD Research Center, University of California at San Diego, La Jolla, CA, USA.
- Division of Gastroenterology, Department of Medicine, University of California at San Diego, La Jolla, CA, USA.
- Division of Epidemiology, Department of Family and Preventive Medicine, University of California at San Diego, La Jolla, CA, USA.
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40
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Quantitative, noninvasive MRI characterization of disease progression in a mouse model of non-alcoholic steatohepatitis. Sci Rep 2021; 11:6105. [PMID: 33731798 PMCID: PMC7971064 DOI: 10.1038/s41598-021-85679-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 02/28/2021] [Indexed: 12/17/2022] Open
Abstract
Non-alcoholic steatohepatitis (NASH) is an increasing cause of chronic liver disease characterized by steatosis, inflammation, and fibrosis which can lead to cirrhosis, hepatocellular carcinoma, and mortality. Quantitative, noninvasive methods for characterizing the pathophysiology of NASH at both the preclinical and clinical level are sorely needed. We report here a multiparametric magnetic resonance imaging (MRI) protocol with the fibrogenesis probe Gd-Hyd to characterize fibrotic disease activity and steatosis in a common mouse model of NASH. Mice were fed a choline-deficient, L-amino acid-defined, high-fat diet (CDAHFD) to induce NASH with advanced fibrosis. Mice fed normal chow and CDAHFD underwent MRI after 2, 6, 10 and 14 weeks to measure liver T1, T2*, fat fraction, and dynamic T1-weighted Gd-Hyd enhanced imaging of the liver. Steatosis, inflammation, and fibrosis were then quantified by histology. NASH and fibrosis developed quickly in CDAHFD fed mice with strong correlation between morphometric steatosis quantification and liver fat estimated by MRI (r = 0.90). Sirius red histology and collagen quantification confirmed increasing fibrosis over time (r = 0.82). Though baseline T1 and T2* measurements did not correlate with fibrosis, Gd-Hyd signal enhancement provided a measure of the extent of active fibrotic disease progression and correlated strongly with lysyl oxidase expression. Gd-Hyd MRI accurately detects fibrogenesis in a mouse model of NASH with advanced fibrosis and can be combined with other MR measures, like fat imaging, to more accurately assess disease burden.
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41
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Huang J, Ou W, Wang M, Singh M, Liu Y, Liu S, Wu Y, Zhu Y, Kumar R, Lin S. MAFLD Criteria Guide the Subtyping of Patients with Fatty Liver Disease. Risk Manag Healthc Policy 2021; 14:491-501. [PMID: 33603515 PMCID: PMC7881793 DOI: 10.2147/rmhp.s285880] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 11/25/2020] [Indexed: 12/12/2022] Open
Abstract
Background and Aims Metabolic associated fatty liver disease (MAFLD) is diagnosed in patients with hepatic steatosis when they have the following three metabolic conditions: obesity/overweight, diabetes and metabolic dysregulation, either alone or in combination. There is no clarity whether subtypes of MAFLD diagnosed by different metabolic conditions carry different levels of risk for intra- and extra-hepatic organs. This study aims to depict the characteristics of these subtypes in a large population. Methods The data were retrieved from the third National Health and Nutrition Examination Surveys of the United States. The clinical and biochemical features in different MAFLD subtypes were compared. The outcome of interest was significant and advanced fibrosis. Results Out of 4,087 (31.24%) participants with MAFLD, 1,165 (28.51%) were diagnosed by single metabolic condition, 2,053 (50.23%) by two conditions, and 869 (21.26%) by all three metabolic conditions. With increasing numbers of metabolic conditions, participants tended to be older, were more likely to be female, and had more severe renal impairment and liver fibrosis (P<0.05). MAFLD patients with a lower number of metabolic conditions were more likely to have excessive alcohol consumption. Among MAFLD with single metabolic condition, those diagnosed by diabetes alone had the highest proportion of advanced fibrosis identified by non-invasive fibrosis models (P<0.05). Conclusion More metabolic conditions upon the diagnosis of MALFD indicate higher risk of fibrosis. Patients with MAFLD diagnosed by diabetes alone are more likely to have advanced hepatic fibrosis than those with other metabolic conditions alone. Individualized management is required for MAFLD with different subtypes.
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Affiliation(s)
- Jiaofeng Huang
- Department of Hepatology, Hepatology Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, People's Republic of China
| | - Weijie Ou
- Department of Hepatology, Hepatology Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, People's Republic of China
| | - Mingfang Wang
- Department of Hepatology, Hepatology Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, People's Republic of China
| | - Medha Singh
- Department of General Medicine, Tan Tock Seng Hospital, Singapore
| | - Yuxiu Liu
- Department of Hepatology, Hepatology Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, People's Republic of China
| | - Shiying Liu
- Department of Hepatology, Hepatology Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, People's Republic of China
| | - Yinlian Wu
- Department of Hepatology, Hepatology Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, People's Republic of China
| | - Yueyong Zhu
- Department of Hepatology, Hepatology Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, People's Republic of China.,Fujian Key Laboratory of Precison Medicine for Cancer, The First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, People's Republic of China
| | - Rahul Kumar
- Department of Gastroenterology and Hepatology, Duke-NUS Academic Medical Centre, Changi General Hospital, Singapore
| | - Su Lin
- Department of Hepatology, Hepatology Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, People's Republic of China
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Figge A, Jähnert A, Canbay A. [The harmfulness of simple steatosis]. Dtsch Med Wochenschr 2021; 146:146-151. [PMID: 33513646 DOI: 10.1055/a-1156-0875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Over the past decades, non-alcoholic fatty liver disease (NAFLD) has emerged as the leading cause of chronic liver diseases in western societies. While the complications of NAFLD progression and particularly non-alcoholic steatohepatitis (NASH) have been widely recognized and statistically proven by emerging numbers of NASH related cirrhosis, transplantations and liver cancer, simple steatosis was widely recognized as a rather benign manifestation of NAFLD. However, emerging data suggests simple steatosis to be associated with increased mortality, related to hepatic- and extrahepatic manifestations of multiple metabolic and inflammatory complications of the disease. This brief review focusses on novel aspects related to the pathogenesis and clinical relevance of simple steatosis. Based on these findings, we recommend a thorough interdisciplinary approach to patients with simple steatosis by dedicated specialized centers. The rising prevalence demands the implementation and evaluation of non-invasive screening methods and multidisciplinary preventive approaches, as according to current data, we face an epidemic of hepatic steatosis in over 25 % of the population.
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43
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Polyzos SA, Mantzoros CS. Making progress in nonalcoholic fatty liver disease (NAFLD) as we are transitioning from the era of NAFLD to dys-metabolism associated fatty liver disease (DAFLD). Metabolism 2020; 111S:154318. [PMID: 32707055 PMCID: PMC7372254 DOI: 10.1016/j.metabol.2020.154318] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 07/11/2020] [Indexed: 12/14/2022]
Abstract
• This is a special issue of “Metabolism” dedicated to nonalcoholic fatty liver disease. • Experts in the field provide an overview of recent progress and developments in NAFLD and offer their expert opinion on future directions. • NAFLD remains a highly prevalent disease without an approved treatment.
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Affiliation(s)
- Stergios A Polyzos
- First Laboratory of Pharmacology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Christos S Mantzoros
- Department of Internal Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Section of Endocrinology, Boston VA Healthcare System, Harvard Medical School, Boston, MA, USA.
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44
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Younossi ZM, Wong VWS, Anstee QM, Romero-Gomez M, Trauner MH, Harrison SA, Lawitz EJ, Okanoue T, Camargo M, Kersey K, Myers RP, Goodman Z, Stepanova M. Fatigue and Pruritus in Patients with Advanced Fibrosis Due to Nonalcoholic Steatohepatitis: The Impact on Patient-Reported Outcomes. Hepatol Commun 2020; 4:1637-1650. [PMID: 33163834 PMCID: PMC7603531 DOI: 10.1002/hep4.1581] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/09/2020] [Accepted: 06/25/2020] [Indexed: 12/29/2022] Open
Abstract
Fatigue and pruritus are common in patients with chronic liver diseases of all etiologies, but clinical awareness is mostly restricted to those with cholestatic liver diseases. We assessed the impact of fatigue and pruritus on patient‐reported outcomes (PROs) of patients with advanced nonalcoholic steatohepatitis (NASH). Specifically, PROs (Short Form–36, Chronic Liver Disease Questionnaire–NASH, Euro‐Qol 5 Dimension, and Work Productivity and Activity Impairment instruments) were assessed at baseline in patients with histologically confirmed bridging fibrosis (F3) or compensated cirrhosis (F4) due to NASH enrolled in STELLAR 3 and 4. Presence of fatigue and pruritus were indicated by a score of 4 or less on the respective items of the Chronic Liver Disease Questionnaire–NASH (scale range, 1‐7). Among the included 1,669 patients with advanced NASH (mean age = 58 ± 9 years, 48% F3, 42% with psychiatric comorbidities), 33% and 27% had fatigue and pruritus, respectively. Patients with NASH with fatigue were younger, more likely to be female, cirrhotic, and diabetic, and had higher body mass index and more comorbidities (all P < 0.05). All PRO scores of patients with fatigue were significantly impaired (mean up to −31% of a PRO range size in comparison to patients without fatigue). In multivariate analysis, predictors of fatigue included diabetes, history of depression or nervous system comorbidities, and lower serum albumin (P < 0.05). Patients with pruritus had demographic characteristics similar to those with fatigue, but a higher prevalence of dermatologic comorbidities. All PROs were impaired (by up to −19% of a range size, all P < 0.01) in patients with NASH with pruritus. Female gender, lower serum albumin, and a history of depression, nervous system, and dermatologic comorbidities were associated with increased risk of pruritus (P < 0.05). Conclusion: Clinically significant fatigue and pruritus are common in patients with advanced NASH, and these symptoms negatively affect PROs.
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Affiliation(s)
- Zobair M Younossi
- Betty and Guy Beatty Center for Integrated Research Inova Health System Falls Church VA USA.,Department of Medicine Center for Liver Diseases Inova Fairfax Hospital Falls Church VA USA
| | | | - Quentin M Anstee
- Clinical & Translational Research Institute Faculty of Medical Sciences Newcastle University Newcastle upon Tyne United Kingdom.,Newcastle NIHR Biomedical Research Centre Newcastle upon Tyne Hospitals NHS Foundation Trust Newcastle-upon-Tyne United Kingdom
| | - Manuel Romero-Gomez
- Digestive Diseases UCM Virgen del Rocio University Hospital Institute of Biomedicine of Seville University of Seville Seville Spain
| | - Michael H Trauner
- Division of Gastroenterology and Hepatology Medical University of Vienna Vienna Austria
| | - Stephen A Harrison
- Radcliffe Department of Medicine Oxford University Oxford United Kingdom
| | - Eric J Lawitz
- Texas Liver Institute University of Texas Health San Antonio San Antonio TX USA
| | | | | | | | | | - Zachary Goodman
- Betty and Guy Beatty Center for Integrated Research Inova Health System Falls Church VA USA.,Department of Medicine Center for Liver Diseases Inova Fairfax Hospital Falls Church VA USA
| | - Maria Stepanova
- Center for Outcomes Research in Liver Disease Washington DC USA
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45
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Idalsoaga F, Kulkarni AV, Mousa OY, Arrese M, Arab JP. Non-alcoholic Fatty Liver Disease and Alcohol-Related Liver Disease: Two Intertwined Entities. Front Med (Lausanne) 2020; 7:448. [PMID: 32974366 PMCID: PMC7468507 DOI: 10.3389/fmed.2020.00448] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 07/06/2020] [Indexed: 12/12/2022] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease worldwide, with a prevalence of 25-30%. Since its first description in 1980, NAFLD has been conceived as a different entity from alcohol-related fatty liver disease (ALD), despite that, both diseases have an overlap in the pathophysiology, share genetic-epigenetic factors, and frequently coexist. Both entities are characterized by a broad spectrum of histological features ranging from isolated steatosis to steatohepatitis and cirrhosis. Distinction between NAFLD and ALD is based on the amount of consumed alcohol, which has been arbitrarily established. In this context, a proposal of positive criteria for NAFLD diagnosis not considering exclusion of alcohol consumption as a prerequisite criterion for diagnosis had emerged, recognizing the possibility of a dual etiology of fatty liver in some individuals. The impact of moderate alcohol use on the severity of NAFLD is ill-defined. Some studies suggest protective effects in moderate doses, but current evidence shows that there is no safe threshold for alcohol consumption for NAFLD. In fact, given the synergistic effect between alcohol consumption, obesity, and metabolic dysfunction, it is likely that alcohol use serves as a significant risk factor for the progression of liver disease in NAFLD and metabolic syndrome. This also affects the incidence of hepatocellular carcinoma. In this review, we summarize the overlapping pathophysiology of NAFLD and ALD, the current data on alcohol consumption in patients with NAFLD, and the effects of metabolic dysfunction and overweight in ALD.
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Affiliation(s)
- Francisco Idalsoaga
- Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Anand V Kulkarni
- Department of Hepatology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Omar Y Mousa
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, United States.,Division of Gastroenterology and Hepatology, Mayo Clinic Health System, Mankato, MN, United States
| | - Marco Arrese
- Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.,Centro de Envejecimiento y Regeneración (CARE), Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Juan Pablo Arab
- Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.,Centro de Envejecimiento y Regeneración (CARE), Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
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