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Ogawa Y, Tomeno W, Imamura Y, Baba M, Ueno T, Kobayashi T, Iwaki M, Nogami A, Kessoku T, Honda Y, Notsumata K, Fujikawa H, Kaai M, Imajo K, Kawanaka M, Hyogo H, Hisatomi M, Takeuchi M, Hakamada T, Honda T, Tatsuta M, Morishita A, Mikami S, Furuya K, Manabe N, Kamada T, Kawaguchi T, Yoneda M, Saito S, Nakajima A. Distribution of Fibrosis-4 index and vibration-controlled transient elastography-derived liver stiffness measurement for patients with metabolic dysfunction-associated steatotic liver disease in health check-up. Hepatol Res 2024. [PMID: 39364641 DOI: 10.1111/hepr.14117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 09/04/2024] [Accepted: 09/08/2024] [Indexed: 10/05/2024]
Abstract
AIMS The multisociety consensus nomenclature has introduced steatotic liver disease (SLD) with diverse subclassifications, which are metabolic dysfunction-associated steatotic liver disease (MASLD), metabolic dysfunction and alcohol-associated steatotic liver disease (MetALD), alcohol-associated liver disease (ALD), specific etiology, and cryptogenic. We investigated their prevalence, as per the new definition, in individuals undergoing health check-ups. Additionally, we analyzed the distribution of Fibrosis-4 (FIB-4) index and vibration-controlled transient elastography (VCTE)-derived liver stiffness measurement (LSM) for MASLD. METHODS In this cross-sectional study, 6530 subjects undergoing a health check-up in Japan were included. Conventional B-mode ultrasound was carried out on all 6530 subjects, and those with MASLD underwent VCTE. RESULTS The prevalence of SLD was 39.5%, comprising MASLD 28.7%, MetALD 8.6%, ALD 1.2%, specific etiology SLD 0.3%, and cryptogenic SLD 0.7%. Subjects with VCTE-derived LSM ≥8 kPa constituted 2.1% of MASLD. FIB-4 ≥1.3 showed that the sensitivity, specificity, positive predictive value (PPV), and negative predictive value for diagnosing VCTE-derived LSM ≥8 kPa were 60.6%, 77.0%, 5.3%, and 98.9%, respectively. The referral rate to specialists was 23.8% using FIB-4 ≥1.30. "FIB-4 ≥1.3 in subjects <65 years and FIB-4 ≥2.0 in subjects ≥65 years" showed higher PPV (6.7%) and lower referral rate (17.1%) compared with FIB-4 ≥1.3, but the sensitivity (54.5%) did not show adequate diagnostic capability as a noninvasive test for diagnosing VCTE-derived LSM ≥8 kPa. CONCLUSIONS Acknowledging the selection bias in hepatology centers, we undertook this prospective health check-up study. Although the FIB-4 index proves to be a convenient marker, it might not perform well as a primary screening tool for liver fibrosis in the general population (UMIN Clinical Trials Registry No. UMIN000035188).
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Affiliation(s)
- Yuji Ogawa
- Department of Gastroenterology, NHO Yokohama Medical Center, Yokohama, Japan
| | - Wataru Tomeno
- Department of Gastroenterology, International University of Health and Welfare Atami Hospital, Atami, Japan
| | - Yasushi Imamura
- Department of Hepatology, Kagoshima Kouseiren Hospital, Kagoshima, Japan
| | - Masaru Baba
- Department of Gastroenterology and Hepatology, JCHO Hokkaido Hospital, Sapporo, Japan
| | - Takato Ueno
- Division of Research Center for Innovative Cancer Therapy, Kurume University, Kurume, Japan
| | - Takashi Kobayashi
- Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Michihiro Iwaki
- Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Asako Nogami
- Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Takaomi Kessoku
- Department of Palliative Care, International University of Health and Welfare Narita Hospital, Narita, Japan
- Department of Internal Medicine, Kanagawa Dental University Yokohama Clinic, Yokohama, Japan
| | - Yasushi Honda
- Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Kazuo Notsumata
- Department of Gastroenterology, Fukui-ken Saiseikai Hospital, Fukui, Japan
| | - Hirotoshi Fujikawa
- Department of Gastroenterology, JCHO Yokohama Chuo Hospital, Yokohama, Japan
| | - Megumi Kaai
- Department of Gastroenterology, Shin-yurigaoka General Hospital, Kawasaki, Japan
| | - Kento Imajo
- Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
- Department of Gastroenterology, Shin-yurigaoka General Hospital, Kawasaki, Japan
| | - Miwa Kawanaka
- Department of General Internal Medicine 2, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Hideyuki Hyogo
- Department of Internal Medicine, Hyogo Life Care Clinic Hiroshima, Hiroshima, Japan
| | - Mitsurou Hisatomi
- Department of Gastroenterology, Tsushima City Hospital, Tsushima, Japan
| | - Mamiko Takeuchi
- Department of Gastroenterology, Anjo Kosei Hospital, Anjo, Japan
| | - Taku Hakamada
- Department of Gastroenterology, Shin-yurigaoka General Hospital, Kawasaki, Japan
| | - Takashi Honda
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Miwa Tatsuta
- Department of Gastroenterology, KKR Takamatsu Hospital, Takamatsu, Japan
| | - Asahiro Morishita
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kita-gun, Japan
| | - Shigeru Mikami
- Department of Internal Medicine, Division of Gastroenterology, Kikkoman General Hospital, Noda, Japan
| | - Ken Furuya
- Department of Gastroenterology and Hepatology, JCHO Hokkaido Hospital, Sapporo, Japan
| | - Noriaki Manabe
- Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Tomoari Kamada
- Department of Health Care Medicine, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Takumi Kawaguchi
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Masato Yoneda
- Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Satoru Saito
- Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
- Department of Gastroenterology, Sanno Hospital, Tokyo, Japan
| | - Atsushi Nakajima
- Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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Tamaki N, Kimura T, Wakabayashi SI, Umemura T, Izumi N, Loomba R, Kurosaki M. Cardiometabolic criteria as predictors and treatment targets of liver-related events and cardiovascular events in metabolic dysfunction-associated steatotic liver disease. Aliment Pharmacol Ther 2024; 60:1033-1041. [PMID: 39115116 DOI: 10.1111/apt.18205] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Revised: 07/07/2024] [Accepted: 07/30/2024] [Indexed: 09/25/2024]
Abstract
BACKGROUND The diagnosis of metabolic dysfunction-associated steatotic liver disease (MASLD) requires at least one of five cardiometabolic criteria. It is unclear whether these criteria can be used as predictors and treatment targets for complications including liver-related events and major adverse cardiovascular events (MACE). AIMS To investigate the relationship between cardiometabolic criteria and complications. METHODS We conducted a nationwide, population-based study of 979,352 patients with MASLD. We investigated relationships between a number of criteria at baseline and liver-related events or MACE risks. In a separate longitudinal analysis, we included patients with five criteria at baseline and investigated the relationship between improving the criteria and the incidence of complications after 1 year. RESULTS The cumulative incidence of MACE, but not liver-related events, increased with increasing baseline cardiometabolic criteria. In the longitudinal study, multivariable analysis using patients with five criteria (no improvement) as the reference, adjusted hazard ratios (95% confidence interval) of MACE in patients with 4, 3, 2, and 0-1 criteria (1 to 4-5 criteria improvement) were 0.55 (0.52-0.58, p < 0.001), 0.20 (0.17-0.22, p < 0.001), 0.13 (0.11-0.16, p < 0.001), and 0.06 (0.02-0.3, p < 0.001), respectively. The risk of MACE decreased as the cardiometabolic criteria improved. There was no significant association between improvement of the criteria and liver-related events. CONCLUSIONS Cardiometabolic criteria can be used as predictors and treatment targets for cardiovascular event risk in MASLD. Developing predictors and therapeutic targets for liver-related events is a future challenge.
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Affiliation(s)
- Nobuharu Tamaki
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Takefumi Kimura
- Division of Gastroenterology, Department of Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Shun-Ichi Wakabayashi
- Division of Gastroenterology, Department of Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Takeji Umemura
- Division of Gastroenterology, Department of Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Namiki Izumi
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Rohit Loomba
- MASLD Research Center, Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Deigo, La Jolla, California, USA
| | - Masayuki Kurosaki
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan
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Ábel T, Benczúr B, Csobod ÉC. Sex differences in pathogenesis and treatment of dyslipidemia in patients with type 2 diabetes and steatotic liver disease. Front Med (Lausanne) 2024; 11:1458025. [PMID: 39376658 PMCID: PMC11456427 DOI: 10.3389/fmed.2024.1458025] [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: 07/01/2024] [Accepted: 08/26/2024] [Indexed: 10/09/2024] Open
Abstract
Previously published studies have shown that women with type 2 diabetes have a higher risk of atherosclerotic cardiovascular disease than men with type 2 diabetes. The exact reason for this is not yet known. The association between metabolic dysfunction-associated steatotic liver disease and type 2 diabetes appears to be bidirectional, meaning that the onset of one may increase the risk of the onset and progression of the other. Dyslipidemia is common in both diseases. Our aim was therefore to investigate whether there is a sex difference in the pathogenesis and management of dyslipidemia in patients with type 2 diabetes and steatotic liver disease with metabolic dysfunction. While the majority of published studies to date have found no difference between men and women in statin treatment, some studies have shown reduced effectiveness in women compared to men. Statin treatment is under-prescribed for both type 2 diabetics and patients with dysfunction-associated steatotic liver disease. No sex differences were found for ezetimibe treatment. However, to the best of our knowledge, no such study was found for fibrate treatment. Conflicting results on the efficacy of newer cholesterol-lowering PCSK9 inhibitors have been reported in women and men. Results from two real-world studies suggest that up-titration of statin dose improves the efficacy of PCSK9 inhibitors in women. Bempedoic acid treatment has been shown to be effective and safe in patients with type 2 diabetes and more effective in lipid lowering in women compared to men, based on phase 3 results published to date. Further research is needed to clarify whether the sex difference in dyslipidemia management shown in some studies plays a role in the risk of ASCVD in patients with type 2 diabetes and steatotic liver disease with metabolic dysfunction.
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Affiliation(s)
- Tatjana Ábel
- Department of Dietetics and Nutritional Sciences, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary
| | - Béla Benczúr
- Department of Dietetics and Nutritional Sciences, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary
- János Balassa County Hospital, Ist Department of Internal medicine (Cardiology/Nephrology), Szekszárd, Hungary
| | - Éva Csajbókné Csobod
- Department of Dietetics and Nutritional Sciences, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary
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Fujii H, Kamada Y, Tokushige A, Watanabe T, Kawada N. Is liver fibrosis more advanced in MetALD than in MASLD? J Hepatol 2024:S0168-8278(24)02436-X. [PMID: 39084472 DOI: 10.1016/j.jhep.2024.07.028] [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: 07/17/2024] [Accepted: 07/24/2024] [Indexed: 08/02/2024]
Affiliation(s)
- Hideki Fujii
- Department of Hepatology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan.
| | - Yoshihiro Kamada
- Department of Advanced Metabolic Hepatology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Akihiro Tokushige
- Department of Clinical Pharmacology and Therapeutics, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Toshio Watanabe
- Department of Premier Preventive Medicine, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Norifumi Kawada
- Department of Hepatology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
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Tamaki N, Kimura T, Wakabayashi SI, Umemura T, Izumi N, Loomba R, Kurosaki M. Editorial: Has MetALD met the presumption? Authors' reply. Aliment Pharmacol Ther 2024; 60:99-100. [PMID: 38757828 DOI: 10.1111/apt.18047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
LINKED CONTENTThis article is linked to Tamaki et al papers. To view these articles, visit https://doi.org/10.1111/apt.18015 and https://doi.org/10.1111/apt.18034
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Affiliation(s)
- Nobuharu Tamaki
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Takefumi Kimura
- Division of Gastroenterology, Department of Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Shun-Ichi Wakabayashi
- Division of Gastroenterology, Department of Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Takeji Umemura
- Division of Gastroenterology, Department of Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Namiki Izumi
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Rohit Loomba
- Division of Gastroenterology and Hepatology, Department of Medicine, MASLD Research Center, University of California San Deigo, La Jolla, California, USA
| | - Masayuki Kurosaki
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan
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