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Livingston M, Gilmore W, Taylor N, Chikritzhs T, Yuen WS, Howell J, Flores E, Curtis M, Dietze P. Age, period and cohort trends in hospital admissions for alcohol-related liver disease in Australia, 1993-2020. Drug Alcohol Rev 2025. [PMID: 40299787 DOI: 10.1111/dar.14063] [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: 09/04/2024] [Revised: 03/19/2025] [Accepted: 04/03/2025] [Indexed: 05/01/2025]
Abstract
INTRODUCTION This study examines trends in admissions for alcohol-related liver disease (ALD) for Australian men and women between 1993 and 2020 and disaggregates these trends into age, period and cohort components. METHOD Retrospective age-period-cohort analysis of hospital admissions with a primary diagnosis of ALD. SETTING Australia. CASES 133,705 hospital admissions - 97,755 men (73%); 35,950 women (27%). MEASUREMENTS Hospital admissions for ALD were grouped into five-year age groups (15-19, 20-24 up to 85 and over) for each financial year between 1992/93 and 2020/21. RESULTS ALD admission rates were substantially higher for men than women. Rates for men increased up to 2005 and subsequently declined before an uptick in 2020. For women, rates increased steadily over the period. In age-period-cohort models, male admission rates were relatively stable over both period and cohort. For women, period effects increased steadily - compared to the period reference year of 2006, the RR for women's admission rates was 0.69 (0.65, 0.74) in 1993, increasing to 1.23 (1.18, 1.29) in 2020. Recent cohorts had significantly higher rates of hospital admission for ALD than those born earlier (e.g., women born in the 1996 cohort had an RR of 2.2 (1.8, 2.7) relative to those born in the reference year 1956). DISCUSSION AND CONCLUSIONS Increases in hospital admissions for ALD, especially since the COVID-19 pandemic, point to the need for effective identification and interventions for people with alcohol-use disorders at risk of chronic disease outcomes.
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Affiliation(s)
- Michael Livingston
- National Drug Research Institute, enAble Institute, Faculty of Health Sciences, Curtin University, Melbourne, Australia
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
- The Burnet Institute, Melbourne, Australia
| | - Will Gilmore
- National Drug Research Institute, enAble Institute, Faculty of Health Sciences, Curtin University, Melbourne, Australia
| | - Nic Taylor
- National Drug Research Institute, enAble Institute, Faculty of Health Sciences, Curtin University, Melbourne, Australia
- The Burnet Institute, Melbourne, Australia
| | - Tanya Chikritzhs
- National Drug Research Institute, enAble Institute, Faculty of Health Sciences, Curtin University, Melbourne, Australia
| | - Wing See Yuen
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Jessica Howell
- The Burnet Institute, Melbourne, Australia
- St Vincent's Hospital Melbourne, Melbourne, Australia
- Department of Medicine, University of Melbourne, Melbourne, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Ericka Flores
- St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Michael Curtis
- National Drug Research Institute, enAble Institute, Faculty of Health Sciences, Curtin University, Melbourne, Australia
- The Burnet Institute, Melbourne, Australia
| | - Paul Dietze
- National Drug Research Institute, enAble Institute, Faculty of Health Sciences, Curtin University, Melbourne, Australia
- The Burnet Institute, Melbourne, Australia
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De Nardo W, Lee O, Johari Y, Bayliss J, Pensa M, Miotto PM, Keenan SN, Ryan A, Rucinski A, Svinos TM, Ooi GJ, Brown WA, Kemp W, Roberts SK, Parker BL, Montgomery MK, Larance M, Burton PR, Watt MJ. Integrated liver-secreted and plasma proteomics identify a predictive model that stratifies MASH. Cell Rep Med 2025:102085. [PMID: 40250425 DOI: 10.1016/j.xcrm.2025.102085] [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: 11/10/2024] [Revised: 01/30/2025] [Accepted: 03/21/2025] [Indexed: 04/20/2025]
Abstract
Obesity is a major risk factor for metabolic-associated steatotic liver disease (MASLD), which can progress to metabolic-associated steatohepatitis (MASH). There are no validated non-invasive tests to stratify persons with obesity with a greater risk for MASH. Herein, we assess plasma and liver from 266 obese individuals spanning the MASLD spectrum. Ninety-six human livers were precision-cut, and mass spectrometry-based proteomics identifies 3,333 proteins in the liver-secretion medium, of which 107 are differentially secreted in MASH compared with no pathology. The plasma proteome is markedly remodeled in MASH but is not different between patients with steatosis and no pathology. The APASHA model, comprising plasma apolipoprotein F (APOF), proprotein convertase subtilisin/kexin type 9 (PCSK9), afamin (AFM), S100 calcium-binding protein A6 (S100A6), HbA1c, and zinc-alpha-2-glycoprotein (AZGP1), stratifies MASH (area under receiver operating characteristic [AUROC] = 0.88). Our investigations detail the evolution of liver-secreted and plasma proteins with MASLD progression, providing a rich resource defining human liver-secreted proteins and creating a predictive model to stratify patients with obesity at risk of MASH.
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Affiliation(s)
- William De Nardo
- Department of Anatomy and Physiology, School of Biomedical Sciences, Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Melbourne, VIC 3010, Australia
| | - Olivia Lee
- Department of Anatomy and Physiology, School of Biomedical Sciences, Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Melbourne, VIC 3010, Australia
| | - Yazmin Johari
- Department of Surgery, School of Translational Medicine, Monash University, Melbourne, VIC 3004, Australia; Bariatric Unit, Department of General Surgery, The Alfred Hospital, Melbourne, VIC 3004, Australia
| | - Jacqueline Bayliss
- Department of Anatomy and Physiology, School of Biomedical Sciences, Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Melbourne, VIC 3010, Australia
| | - Marcus Pensa
- Department of Anatomy and Physiology, School of Biomedical Sciences, Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Melbourne, VIC 3010, Australia
| | - Paula M Miotto
- Department of Anatomy and Physiology, School of Biomedical Sciences, Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Melbourne, VIC 3010, Australia
| | - Stacey N Keenan
- Department of Anatomy and Physiology, School of Biomedical Sciences, Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Melbourne, VIC 3010, Australia
| | - Andrew Ryan
- TissuPath, Mount Waverley, VIC 3149, Australia
| | - Amber Rucinski
- Department of Oncology, Bendigo Health, Bendigo, VIC 3550, Australia
| | - Tessa M Svinos
- Department of General Surgery, Barwon Health, Geelong, VIC 3220, Australia
| | - Geraldine J Ooi
- Department of Surgery, School of Translational Medicine, Monash University, Melbourne, VIC 3004, Australia; Bariatric Unit, Department of General Surgery, The Alfred Hospital, Melbourne, VIC 3004, Australia
| | - Wendy A Brown
- Department of Surgery, School of Translational Medicine, Monash University, Melbourne, VIC 3004, Australia; Bariatric Unit, Department of General Surgery, The Alfred Hospital, Melbourne, VIC 3004, Australia
| | - William Kemp
- Department of Gastroenterology, The Alfred Hospital and Monash University, Melbourne, VIC 3181, Australia
| | - Stuart K Roberts
- Department of Gastroenterology, The Alfred Hospital and Monash University, Melbourne, VIC 3181, Australia
| | - Benjamin L Parker
- Department of Anatomy and Physiology, School of Biomedical Sciences, Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Melbourne, VIC 3010, Australia
| | - Magdalene K Montgomery
- Department of Anatomy and Physiology, School of Biomedical Sciences, Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Melbourne, VIC 3010, Australia
| | - Mark Larance
- Charles Perkins Centre and School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Paul R Burton
- Department of Surgery, School of Translational Medicine, Monash University, Melbourne, VIC 3004, Australia; Bariatric Unit, Department of General Surgery, The Alfred Hospital, Melbourne, VIC 3004, Australia
| | - Matthew J Watt
- Department of Anatomy and Physiology, School of Biomedical Sciences, Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Melbourne, VIC 3010, Australia.
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Tulleners R, Barnett A, O'Beirne J, Powell E, Hickman IJ, Valery PC, Kularatna S, Stuart K, McIvor C, Witness E, Aikebuse M, Brain D. Parallel randomised trial testing community fibrosis assessment for suspected non-alcoholic fatty liver disease: outcomes from LOCATE-NAFLD. BMJ Open Gastroenterol 2024; 11:e001418. [PMID: 39797660 PMCID: PMC11664381 DOI: 10.1136/bmjgast-2024-001418] [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: 03/25/2024] [Accepted: 11/07/2024] [Indexed: 01/13/2025] Open
Abstract
OBJECTIVE Non-alcoholic fatty liver disease (NAFLD) is estimated to affect a third of Australian adults, and its prevalence is predicted to rise, increasing the burden on the healthcare system. The LOCal Assessment and Triage Evaluation of Non-Alcoholic Fatty Liver Disease (LOCATE-NAFLD) trialled a community-based fibrosis assessment service using FibroScan to reduce the time to diagnosis of high-risk NAFLD and improve patient outcomes. METHODS We conducted a 1:1 parallel randomised trial to compare two alternative models of care for NAFLD diagnosis and assessment. Participants had suspected NAFLD and were referred to a hepatology clinic in one of three major hospitals in South-East Queensland. Eligible consenting participants were randomised to receive usual care or the intervention (LOCATE). Participants in the intervention arm received a FibroScan outside of the hospital setting, with results provided to their primary care provider and the referring hepatologist. All participants were followed up 12 months after randomisation to measure their clinical and patient-reported outcomes. RESULTS 97 participants were recruited from October 2020 to December 2022. Of the 50 participants randomised to the intervention arm, one failed to attend their appointment, and of the 48 (98%) who had a FibroScan 13 (27%) had a liver stiffness measurement of 8.0 kPa or greater. The HR for the time to diagnosis of high risk was 1.28 (95% CI 0.59 to 2.79), indicating a faster average time to diagnosis with the intervention, but failing to conclusively demonstrate a faster time. The intervention did greatly reduce the time to FibroScan by almost 1 year (median difference 0.92 years, 95% CI 0.56 to 1.45). Other clinical outcomes showed minimal changes. CONCLUSION The LOCATE model shows potential for impact, particularly in reducing waiting times for patients at high risk of developing severe liver disease due to NAFLD. A larger sample and longer follow-ups are needed to measure additional clinical outcomes. TRIAL REGISTRATION NUMBER ACTRN12620000158965.
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Affiliation(s)
- Ruth Tulleners
- Australian Centre for Health Services Innovation, Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Adrian Barnett
- Australian Centre for Health Services Innovation, Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - James O'Beirne
- University of the Sunshine Coast, Birtinya, Queensland, Australia
- Sunshine Coast University Hospital and Health Service, Birtinya, Queensland, Australia
| | - Elizabeth Powell
- Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
- Centre for Liver Disease Research, Translational Research Institute, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Ingrid J Hickman
- ULTRA Team, The University of Queensland Clinical Trials Capability, Herston, Queensland, Australia
| | - Patricia C Valery
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Sanjeewa Kularatna
- Australian Centre for Health Services Innovation, Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Katherine Stuart
- Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | | | - Elen Witness
- Sunshine Coast University Hospital and Health Service, Birtinya, Queensland, Australia
| | - Melanie Aikebuse
- Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
- Centre for Liver Disease Research, Translational Research Institute, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - David Brain
- Australian Centre for Health Services Innovation, Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia
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Zheng S, Li D, Shi Z, Yang Y, Li L, Chen P, A bulimiti X, Li F. Development and validation of a nomogram for nonalcoholic fatty liver disease in Western Xinjiang, China. Eur J Gastroenterol Hepatol 2024; 36:1220-1229. [PMID: 38916218 PMCID: PMC11361349 DOI: 10.1097/meg.0000000000002807] [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: 02/21/2024] [Accepted: 04/11/2024] [Indexed: 06/26/2024]
Abstract
OBJECTIVE The aim of this study was to establish a simple, nonalcoholic fatty liver disease (NAFLD) screening model using readily available variables to identify high-risk individuals in Western Xinjiang, China. METHODS A total of 40 033 patients from the National Health Examination were divided into a training group (70%) and a validation group (30%). Univariate regression and least absolute shrinkage and selection operator models optimized feature selection, while a multivariate logistic regression analysis constructed the prediction model. The model's performance was evaluated using the area under the receiver operating characteristic curve, and its clinical utility was assessed through decision curve analysis. RESULTS The nomogram assessed NAFLD risk based on factors such as sex, age, diastolic blood pressure, waist circumference, BMI, fasting plasma glucose, alanine aminotransferase, platelet count, total cholesterol, triglycerides, low-density lipoprotein-cholesterol, and high-density lipoprotein-cholesterol. The area under the receiver operating characteristic curves were 0.829 for men and 0.859 for women in the development group, and 0.817 for men and 0.865 for women in the validation group. The decision curve analysis confirmed the nomogram's clinical usefulness, with consistent findings in the validation set. CONCLUSION A user-friendly nomogram prediction model for NAFLD risk was successfully developed and validated for Western Xinjiang, China.
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Affiliation(s)
- Shuaiyin Zheng
- Xinjiang Second Medical College
- Xinjiang Key Laboratory of Clinical Gene Testing and Biomedical Information
| | - Di Li
- Xinjiang Key Laboratory of Clinical Gene Testing and Biomedical Information
- Department of Public Health, Karamay Hospital of People’s Hospital of Xinjiang Uygur Autonomous Region
- Xinjiang Digestive System Tumor Precision Medical Clinical Medical Research Center, Karamay
| | - Zhuoyue Shi
- Department of Public Health, Xinjiang Medical University, Urumqi
| | - Ying Yang
- Department of Public Health, Xinjiang Medical University, Urumqi
| | | | | | | | - Fuye Li
- Department of Public Health, Xinjiang Medical University, Urumqi
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Dick S, Wheeler K, Keating SE. Opportunities for the management of metabolic dysfunction-associated fatty liver disease within Aboriginal and Torres Strait Islander peoples. Aust N Z J Public Health 2024; 48:100138. [PMID: 38442569 DOI: 10.1016/j.anzjph.2024.100138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 01/22/2024] [Accepted: 02/08/2024] [Indexed: 03/07/2024] Open
Affiliation(s)
- Sarah Dick
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Kai Wheeler
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Shelley E Keating
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD, Australia.
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Allen MJ, Doran R, Brain D, Powell EE, O'Beirne J, Valery PC, Barnett A, Hettiarachchi R, Hickman IJ, Kularatna S. A discrete choice experiment to elicit preferences for a liver screening programme in Queensland, Australia: a mixed methods study to select attributes and levels. BMC Health Serv Res 2023; 23:950. [PMID: 37670274 PMCID: PMC10481473 DOI: 10.1186/s12913-023-09934-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 08/17/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND In Australia, the overall prevalence of liver disease is increasing. Maximising uptake of community screening programmes by understanding patient preferences is integral to developing consumer-centred care models for liver disease. Discrete choice experiments (DCEs) are widely used to elicit preferences for various healthcare services. Attribute development is a vital component of a well-designed DCE and should be described in sufficient detail for others to assess the validity of outcomes. Hence, this study aimed to create a list of potential attributes and levels which can be used in a DCE study to elicit preferences for chronic liver disease screening programmes. METHODS Key attributes were developed through a multi-stage, mixed methods design. Focus groups were held with consumers and health care providers on attributes of community screening programmes for liver disease. Stakeholders then prioritised attributes generated from the focus group in order of importance via an online prioritisation survey. The outcomes of the prioritisation exercise were then reviewed and refined by an expert panel to ensure clinically meaningful levels and relevance for a DCE survey. RESULTS Fifteen attributes were generated during the focus group sessions deemed necessary to design liver disease screening services. Outcomes of the prioritisation exercise and expert panel stages recognised five attributes, with three levels each, for inclusion in a DCE survey to elicit consumer preferences for community screening for liver disease. This study also highlights broader social issues such as the stigma around liver disease that require careful consideration by policy makers when designing or implementing a liver screening programme. CONCLUSIONS The attributes and levels identified will inform future DCE surveys to understand consumer preferences for community screening programmes for liver disease. In addition, the outcomes will help inform the implementation of the LOCATE-NAFLD programme in real-world practice, and could be relevant for other liver and non-liver related chronic disease screening programmes.
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Affiliation(s)
- Michelle J Allen
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia.
| | - Rachael Doran
- Department of Economics and Related Studies, University of York, York, UK
| | - David Brain
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Elizabeth E Powell
- The University of Queensland, St Lucia, QLD, Australia
- Centre for Liver Disease Research, Translational Research Institute, Faculty of Medicine, The University of Queensland, Woolloongabba, QLD, Australia
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - James O'Beirne
- University of the Sunshine Coast, Maroochydore DC, QLD, Australia
- Sunshine Coast University Hospital, Birtinya, QLD, Australia
| | | | - Adrian Barnett
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | | | - Ingrid J Hickman
- The University of Queensland, St Lucia, QLD, Australia
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Sanjeewa Kularatna
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
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Hua X, Zhang H, Yang W, Liu G, Zhang S, Wang Y. SFI, a sex hormone binding globulin based nomogram for predicting non-alcoholic fatty liver disease in the Chinese population. Front Endocrinol (Lausanne) 2023; 14:1176019. [PMID: 37334312 PMCID: PMC10276183 DOI: 10.3389/fendo.2023.1176019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/10/2023] [Indexed: 06/20/2023] Open
Abstract
Background The purpose of this study is to establish a novel nomogram model for accurate detection of non-alcoholic fatty liver disease (NAFLD) in the Chinese population based on sex hormone binding globulin (SHBG) and other routine laboratory tests. Methods A total of 1417 participants (1003 testing and 414 validations) were enrolled into the study. Risk factors independently associated with NAFLD were identified and incorporated in the new nomogram, SFI. The performance of nomogram was assessed by analysis of receiver operating characteristic (ROC) curve, calibration curve, and decision curve. Results We formulated a new nomogram incorporating four independent factors: SHBG, body mass index (BMI), ALT/AST, and triglycerides (TG). The nomogram achieved good indexes of area under ROC 0.898 (95% confidence interval 0.865-0.926) in predicting NAFLD, which was significantly superior to previously reported models of FLI, HSI, LFS, and LAP. The calibration curve and decision curve demonstrated high performance and clinical utility of the nomogram in predicting NAFLD. Conclusion The nomogram SFI has high performance in predicting NAFLD in Chinese population and may be used as a cost-effective screening model to assess NAFLD in the general population.
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Affiliation(s)
- Xiaomin Hua
- Department of Health Care, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Shandong, China
| | - Heping Zhang
- Department of Cardiac Surgery, the Affiliated Hospital of Qingdao University, Shandong, China
| | - Wenru Yang
- Department of Health Care, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Shandong, China
| | - Guotao Liu
- Department of Health Care, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Shandong, China
| | - Suhua Zhang
- Department of Health Care, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Shandong, China
| | - Yingcui Wang
- Department of Health Care, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Shandong, China
- Department of Cardiology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Shandong, China
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Teng ML, Ng CH, Huang DQ, Chan KE, Tan DJ, Lim WH, Yang JD, Tan E, Muthiah MD. Global incidence and prevalence of nonalcoholic fatty liver disease. Clin Mol Hepatol 2023; 29:S32-S42. [PMID: 36517002 PMCID: PMC10029957 DOI: 10.3350/cmh.2022.0365] [Citation(s) in RCA: 271] [Impact Index Per Article: 135.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
Nonalcoholic fatty liver disease (NAFLD) is a leading cause of liver disease worldwide. The estimated global incidence of NAFLD is 47 cases per 1,000 population and is higher among males than females. The estimated global prevalence of NAFLD among adults is 32% and is higher among males (40%) compared to females (26%). The global prevalence of NAFLD has increased over time, from 26% in studies from 2005 or earlier to 38% in studies from 2016 or beyond. The prevalence of NAFLD varies substantially by world region, contributed by differing rates of obesity, and genetic and socioeconomic factors. The prevalence of NAFLD exceeds 40% in the Americas and South-East Asia. The prevalence of NAFLD is projected to increase significantly in multiple world regions by 2030 if current trends are left unchecked. In this review, we discuss trends in the global incidence and prevalence of NAFLD and discuss future projections.
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Affiliation(s)
- Margaret Lp Teng
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Cheng Han Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Daniel Q Huang
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- National University Centre for Organ Transplantation, National University Hospital, Singapore
| | - Kai En Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Darren Jh Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Wen Hui Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ju Dong Yang
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Eunice Tan
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- National University Centre for Organ Transplantation, National University Hospital, Singapore
| | - Mark D Muthiah
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- National University Centre for Organ Transplantation, National University Hospital, Singapore
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Welman CJ, Saunders J, Zelesco M, Abbott S, Boardman G, Ayonrinde OT. Hepatic steatosis: Ultrasound assessment using attenuation imaging (ATI) with liver biopsy correlation. J Med Imaging Radiat Oncol 2023; 67:45-53. [PMID: 35466506 DOI: 10.1111/1754-9485.13412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/10/2022] [Accepted: 03/30/2022] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Hepatic steatosis duration and severity are risk factors for liver fibrosis and cardiometabolic disease. We assessed the diagnostic accuracy of attenuation imaging (ATI), compared with histologic hepatosteatosis grading in adults with varied suspected liver pathologies. METHODS Liver biopsy was performed on 76 patients (51 women, 25 men) with non-malignant diffuse parenchymal liver disease, within 4 weeks of multiparametric liver ultrasound including attenuation imaging (ATI). Skin-liver capsule distance (SCD) and body mass index (BMI) were measured. Histologic steatosis was graded none (S0), mild (S1), moderate (S2) or severe (S3). We compared histology and sonographic parameters. RESULTS The median patient age was 50.5 (range 18-83) years and BMI 28.9 kg/m2 (interquartile range 24.0-33.3). The distribution of histologic steatosis grade was S0 (44%), S1(17%), S2(30%) and S3(9%). Median ATI value for each biopsy steatosis grade was 0.60 (IQR: 0.52-0.65), 0.65 (IQR: 0.6-0.71), 0.83 (IQR: 0.74-0.90) and 0.90 (IQR: 0.82-1.01) dB/cm/MHz for S0, S1, S2 and S3, respectively. The AUC of ATI for detection of any steatosis (S1-S3) and moderate to severe steatosis (S2-S3) was 0.85 (95% CI: 0.75-0.91) and 0.91 (95% CI: 0.83-0.99) with cut-offs of 0.55 and 0.62 dB/cm/MHz. ATI threshold of 0.74 dB/cm/MHz was able to discriminate between S0-S1 and S2-3 with accuracy, CI and kappa statistic of 0.8889, 0.65-0.98 and 0.7534. CONCLUSION We found a good correlation between ATI and steatosis grade. The most accurate discrimination was between none to mild (S0-1) and moderate to severe (S2-3) steatosis.
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Affiliation(s)
- Christopher J Welman
- Department of Medical Imaging, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Jacqualine Saunders
- Department of Medical Imaging, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Marilyn Zelesco
- Department of Medical Imaging, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Steven Abbott
- Department of Medical Imaging, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Glenn Boardman
- Data Analyst, Clinical Service Planning & Population Health, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Oyekoya T Ayonrinde
- Department of Gastroenterology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
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10
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Ngu NLY, Flanagan E, Bell S, Le ST. Acute-on-chronic liver failure: Controversies and consensus. World J Gastroenterol 2023; 29:232-240. [PMID: 36687118 PMCID: PMC9846945 DOI: 10.3748/wjg.v29.i2.232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 11/01/2022] [Accepted: 12/21/2022] [Indexed: 01/06/2023] Open
Abstract
Acute-on-chronic liver failure (ACLF) is a poorly defined syndrome characterised by rapid clinical deterioration in patients with chronic liver disease. Consequences include high short-term morbidity, mortality, and healthcare resource utilisation. ACLF encompasses a dysregulated, systemic inflammatory response, which can precipitate extra hepatic organ failures. Common precipitants include infection, alcoholic hepatitis, and reactivation of viral hepatitis although frequently no cause is identified. Heterogenous definitions, diagnostic criteria, and treatment guidelines, have been proposed by international hepatology societies. This can result in delayed or missed diagnoses of ACLF, significant variability in clinical management, and under-estimation of disease burden. Liver transplantation may be considered but the mainstay of treatment is organ support, often in the intensive care unit. This review will provide clarity around where are the controversies and consensus in ACLF including: Epidemiology and resource utilisation, key clinical and diagnostic features, strategies for management, and research gaps.
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Affiliation(s)
- Natalie L Y Ngu
- Department of Gastroenterology and Hepatology, Monash Health, Clayton 3168, Victoria, Australia
- Faculty of Medicine, Nursing, and Health Sciences, Monash University, Clayton 3800, Victoria, Australia
- Department of Gastroenterology and Hepatology, Alfred Health, Melbourne 3004, Victoria, Australia
| | - Eliza Flanagan
- Department of Gastroenterology and Hepatology, Monash Health, Clayton 3168, Victoria, Australia
- Faculty of Medicine, Nursing, and Health Sciences, Monash University, Clayton 3800, Victoria, Australia
- Monash digital Therapeutics and Innovation Laboratory (MoTILa), Monash University, Clayton 3168, Victoria, Australia
| | - Sally Bell
- Department of Gastroenterology and Hepatology, Monash Health, Clayton 3168, Victoria, Australia
- Faculty of Medicine, Nursing, and Health Sciences, Monash University, Clayton 3800, Victoria, Australia
| | - Suong T Le
- Department of Gastroenterology and Hepatology, Monash Health, Clayton 3168, Victoria, Australia
- Faculty of Medicine, Nursing, and Health Sciences, Monash University, Clayton 3800, Victoria, Australia
- Monash digital Therapeutics and Innovation Laboratory (MoTILa), Monash University, Clayton 3168, Victoria, Australia
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11
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Is Hepatocellular Carcinoma in Fatty Liver Different to Non-Fatty Liver? Nutrients 2022; 14:nu14183875. [PMID: 36145251 PMCID: PMC9504716 DOI: 10.3390/nu14183875] [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: 08/26/2022] [Revised: 09/15/2022] [Accepted: 09/15/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) has become the most prevalent liver disease in Australia and is recognised to play a role in the development of hepatocellular carcinoma (HCC). There are no clear guidelines regarding screening for HCC in NAFLD. The aim of this retrospective study was to compare the characteristics and survival rates of NAFLD-HCC to patients with non-NAFLD-HCC to help guide future research in this area. METHODS A total of 152 HCC patients with either NAFLD (n = 36) or non-NAFLD (n = 116) were retrospectively analysed from the HCC database and medical records. Chi-square and independent t-test were used to compare baseline characteristics and Kaplan-Meier curves and Cox models were used for survival analysis. RESULTS Patients with NAFLD-HCC were more likely to be diagnosed due to symptoms rather than through screening, and at an older age, compared with non-NAFLD HCC. The median survival rates were lower in NAFLD-HCC (17.2 months) than in those with non-NAFLD-HCC (23.5 months). CONCLUSION There is a rise in the number of HCC cases in patients with NAFLD, and this has significant implications for hepatologists as they are presented with more advanced diseases and have poorer outcomes. Future studies on HCC will need to identify this group earlier in order to have an impact on the HCC survival rate.
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12
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Mahajan VK, Chauhan NS, Rana BS, Mehta KS, Hooda S, Chauhan PS, Kukreja A. The Association Between Chronic Plaque Psoriasis and Nonalcoholic Fatty Liver Disease in Indian Patients: Results of a Pilot Study. J Clin Exp Hepatol 2022; 12:785-792. [PMID: 35677516 PMCID: PMC9168695 DOI: 10.1016/j.jceh.2021.11.016] [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: 10/04/2021] [Accepted: 11/26/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Psoriasis is a chronic dermatosis with potential to cause systemic disease by triggering dysmetabolism, such as metabolic syndrome and nonalcoholic fatty liver disease (NAFLD). We studied the relationship and associations between NAFLD and clinical features, including age, gender, disease duration, and severity of psoriasis in our patients. METHODS This cross-sectional study comprised 61 (m:f, 43:19) patients without pre-existing comorbidities and matched 24 (m:f, 16:8) healthy controls aged between 20 and 68 years. Disease severity was graded as mild, moderate, and severe by psoriasis area and severity index score and body surface area (BSA) involvement. The grades of fatty liver and liver fibrosis were assessed using liver ultrasonography (USG) and transitional vibration-controlled elastography (Fibroscan). RESULTS Overall, 67.2% of patients were aged >40 years, and the duration of disease was <5years in 60.7% of patients. Mild and moderate to severe psoriasis occurred in 78.7% and 21.3% of patients, respectively. BSA was >10% in 57.5% patients. The proportion of NAFLD was 27.9% and 32.8% by USG and Fibroscan compared with 20.8% in controls. Statistically, there was no significant difference or association between the prevalence of NAFLD among patients and controls, and gender, age (mean ± standard deviation, 47.5 ± 13.8 vs. 45.2 ± 15.7), duration, severity of psoriasis, and arthritis between psoriatic patients with and without NAFLD. CONCLUSION This was a pilot study because of the numerosity of sample and highlights trends for possible link between psoriasis and NAFLD, but the results need cautious interpretation and clinical application. Whether NAFLD can be attributed to overall systemic inflammatory process of psoriasis or it occurs as an epiphenomenon of concurrent metabolic syndrome needs elucidation with well-designed studies. Cross-sectional study design, small number of patients, and controls remain major limitations. The study did not compare its findings with liver biopsy.
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Affiliation(s)
- Vikram K. Mahajan
- Department of Dermatology, Venereology & Leprosy, Dr. Rajendra Prasad Government Medical College, Kangra (Tanda), 176001 Himachal Pradesh, India
| | - Narvir S. Chauhan
- Department of Radio Diagnosis, Dr. Rajendra Prasad Government Medical College, Kangra (Tanda), 176001 Himachal Pradesh, India
| | - Baldev S. Rana
- Department of Gastroenterology & Hepatology, Dr. Rajendra Prasad Government Medical College, Kangra (Tanda), 176001 Himachal Pradesh, India
| | - Karaninder S. Mehta
- Department of Dermatology, Venereology & Leprosy, Dr. Rajendra Prasad Government Medical College, Kangra (Tanda), 176001 Himachal Pradesh, India
| | - Sheenam Hooda
- Department of Dermatology, Venereology & Leprosy, Dr. Rajendra Prasad Government Medical College, Kangra (Tanda), 176001 Himachal Pradesh, India
| | - Pushpinder S. Chauhan
- Department of Dermatology, Venereology & Leprosy, Dr. Rajendra Prasad Government Medical College, Kangra (Tanda), 176001 Himachal Pradesh, India
| | - Amisha Kukreja
- Department of Dermatology, Venereology & Leprosy, Dr. Rajendra Prasad Government Medical College, Kangra (Tanda), 176001 Himachal Pradesh, India
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13
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General Overview About the Current Management of Nonalcoholic Fatty Liver Disease. Clin Drug Investig 2022; 42:39-45. [PMID: 35467297 PMCID: PMC9205790 DOI: 10.1007/s40261-022-01142-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2022] [Indexed: 02/07/2023]
Abstract
Nonalcoholic fatty liver disease includes a wide spectrum of manifestations from simple steatosis to nonalcoholic steatohepatitis, fibrosis, and eventually cirrhosis or even hepatocellular carcinoma. This disorder is also associated with an increased cardiovascular risk, renal involvement, oncologic processes, metabolic disturbances, and an increased risk of all-cause mortality or hepatic mortality. For this reason, nonalcoholic fatty liver disease should be considered a disorder with high morbidity and mortality that must be diagnosed appropriately as soon as possible to establish adequate treatment. Noninvasive methods based on biochemical parameters should be used as a first step in the evaluation of any patient in whom this disease is suspected. However, serum/blood levels of liver enzymes are not a good indicator of liver damage and noninvasive methods, including biochemical tests and imaging, have suboptimal accuracy or are patented prototypes that show limitations in clinical practice. There are currently no drugs specifically approved for the treatment of these liver disorders, thus the most relevant intervention for nonalcoholic fatty liver disease is lifestyle modification.
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14
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Ramachandran P, Xu G, Huang HH, Rice R, Zhou B, Lindpaintner K, Serie D. Serum Glycoprotein Markers in Nonalcoholic Steatohepatitis and Hepatocellular Carcinoma. J Proteome Res 2022; 21:1083-1094. [PMID: 35286803 PMCID: PMC8981307 DOI: 10.1021/acs.jproteome.1c00965] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Fatty liver disease progresses through stages of fat accumulation and inflammation to nonalcoholic steatohepatitis (NASH), fibrosis and cirrhosis, and eventually hepatocellular carcinoma (HCC). Currently available diagnostic tools for HCC lack sensitivity and specificity. In this study, we investigated the use of circulating serum glycoproteins to identify a panel of potential prognostic markers that may be indicative of progression from the healthy state to NASH and further to HCC. Serum samples were processed and analyzed using a novel high-throughput glycoproteomics platform. Our initial dataset contained healthy, NASH, and HCC serum samples. We analyzed 413 glycopeptides, representing 57 abundant serum proteins, and compared among the three phenotypes. We studied the normalized abundance of common glycoforms and found 40 glycopeptides with statistically significant differences in abundances in NASH and HCC compared to controls. Summary level relative abundances of core-fucosylated, sialylated, and branched glycans containing glycopeptides were higher in NASH and HCC as compared to controls. We replicated some of our findings in an independent set of samples of individuals with benign liver conditions and HCC. Our results may be of value in the management of liver diseases. Data generated in this work can be downloaded from MassIVE (https://massive.ucsd.edu) with identifier MSV000088809.
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Affiliation(s)
| | - Gege Xu
- InterVenn Biosciences, South San Francisco, California 94080, United States
| | - Hector H Huang
- InterVenn Biosciences, South San Francisco, California 94080, United States
| | - Rachel Rice
- InterVenn Biosciences, South San Francisco, California 94080, United States
| | - Bo Zhou
- InterVenn Biosciences, South San Francisco, California 94080, United States
| | - Klaus Lindpaintner
- InterVenn Biosciences, South San Francisco, California 94080, United States
| | - Daniel Serie
- InterVenn Biosciences, South San Francisco, California 94080, United States
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15
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Abstract
Metabolic (dysfunction) associated fatty liver disease (MAFLD), previously known as non-alcoholic fatty liver disease, is the most common cause of chronic liver disease worldwide. Many risk factors contribute to the pathogenesis of MAFLD with metabolic dysregulation being the final arbiter of its development and progression. MAFLD poses a substantial economic burden to societies, which based on current trends is expected to increase over time. Numerous studies have addressed various aspects of MAFLD from its risk associations to its economic and social burden and clinical diagnosis and management, as well as the molecular mechanisms linking MAFLD to end-stage liver disease and hepatocellular carcinoma. This review summarizes current understanding of the pathogenesis of MAFLD and related diseases, particularly liver cancer. Potential therapeutic agents for MAFLD and diagnostic biomarkers are discussed.
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16
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Kemp W, Clayton-Chubb D, Majeed A, Glenister KM, Magliano DJ, Lubel J, Bourke L, Simmons D, Roberts SK. Impact of renaming NAFLD to MAFLD in an Australian regional cohort: Results from a prospective population-based study. J Gastroenterol Hepatol 2022; 37:395-403. [PMID: 34693553 DOI: 10.1111/jgh.15723] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 10/13/2021] [Accepted: 10/15/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND AIMS Clinical and public health implications of the recent redefining of non-alcoholic fatty liver disease (NAFLD) to metabolic-associated fatty liver disease (MAFLD) remain unclear. We sought to determine the prevalence and compare MAFLD with NAFLD in a well-defined cohort. METHODS A cross-sectional study was conducted in regional Victoria with participants from randomly selected households. Demographic and health-related clinical and laboratory data were obtained. Fatty liver was defined as a fatty liver index ≥ 60 with MAFLD defined according to recent international expert consensus. RESULTS A total of 722 participants were included. Mean age was 59.3 ± 16 years, and 55.3% were women with a median body mass index of 27.8 kg/m2 . Most (75.2%) participants were overweight or obese. MAFLD was present in 341 participants giving an unadjusted prevalence of 47.2% compared with a NAFLD prevalence of 38.7%. Fifty-nine (17.5%) participants met the criteria of MAFLD but not NAFLD. The increased prevalence of MAFLD in this cohort was primarily driven by dual etiology of fatty liver. All participants classified as NAFLD met the new definition of MAFLD. Compared with NAFLD subjects, participants with MAFLD had higher ALT (26.0 [14.0] U/L vs 30.0 [23] U/L, P = 0.024), but there were no differences in non-invasive markers for steatosis or fibrosis. CONCLUSION Metabolic-associated fatty liver disease is a highly prevalent condition within this large community cohort. Application of the MAFLD definition increased prevalence of fatty liver disease by including people with dual etiologies of liver disease.
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Affiliation(s)
- William Kemp
- Department of Gastroenterology, The Alfred Hospital, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Daniel Clayton-Chubb
- Department of Gastroenterology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Ammar Majeed
- Department of Gastroenterology, The Alfred Hospital, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Kristen M Glenister
- Department of Rural Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Dianna J Magliano
- Diabetes and Population Health, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - John Lubel
- Department of Gastroenterology, The Alfred Hospital, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Lisa Bourke
- Department of Rural Health, University of Melbourne, Melbourne, Victoria, Australia
| | - David Simmons
- Department of Rural Health, University of Melbourne, Melbourne, Victoria, Australia.,Macarthur Clinical School, School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia
| | - Stuart K Roberts
- Department of Gastroenterology, The Alfred Hospital, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
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17
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Majumdar A, Verbeek J, Tsochatzis EA. Non-alcoholic fatty liver disease: Current therapeutic options. Curr Opin Pharmacol 2021; 61:98-105. [PMID: 34688168 DOI: 10.1016/j.coph.2021.09.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/13/2021] [Accepted: 09/20/2021] [Indexed: 12/12/2022]
Abstract
Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease and has an estimated global prevalence of 25%. NAFLD is found in up to 80% of people with obesity and over 60% of patients with diabetes. Cardiovascular disease is the main cause of mortality, followed by extra-hepatic cancers and then liver-specific complications of cirrhosis and hepatocellular carcinoma. Lifestyle modification remains the primary intervention in NAFLD. Weight loss achieved through dietary modification and exercise can lead to histologic improvement and reversal of metabolic complications. Current drug therapy is limited to pioglitazone and vitamin E; however, several agents are currently under phase III development. This review summarises the current treatment options in NAFLD.
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Affiliation(s)
- Avik Majumdar
- AW Morrow Gastroenterology and Liver Centre, Australian National Liver Transplant Unit, Royal Prince Alfred Hospital, Sydney, Australia; Central Clinical School, The University of Sydney, Australia
| | - Jef Verbeek
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium; Laboratory of Hepatology, Department of Chronic Diseases and Metabolism (CHROMETA), KU Leuven, Leuven, Belgium
| | - Emmanuel A Tsochatzis
- UCL Institute for Liver and Digestive Health, Royal Free Hospital and UCL, London, UK; Sheila Sherlock Liver Centre, Royal Free Hospital, London, UK.
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18
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Bishay RH, Meyerowitz-Katz G, Hng TM, Colaco CMG, Khanna S, Klein R, Sanjeev D, McLean M, Ahlenstiel G, Maberly GF. A retrospective case-control cohort analysis of comorbidity and health expenditure in hospitalized adults diagnosed with obesity utilizing ICD-10 diagnostic coding. Clin Obes 2021; 11:e12469. [PMID: 34053198 DOI: 10.1111/cob.12469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/06/2021] [Accepted: 04/27/2021] [Indexed: 11/28/2022]
Abstract
The cost and comorbidity of obesity in hospitalized inpatients, is less known. A retrospective study of patients presenting to a large district hospital in Western Sydney (April 2016-February 2017) using clinical, pathological as well as diagnostic coding data for obesity as per ICD-10. Of 43 212 consecutive hospital presentations, 390 had an obesity-coded diagnosis (Ob, 0.90%), of which 244 were gender and age-matched to a non-obesity coded cohort (NOb). Weight and BMI were higher in the Ob vs NOb group (126 ± 37 vs 82 ± 25 kg; BMI 46 ± 12 vs 29 ± 8 kg/m2 , P < .001) with a medical record documentation rate of 62% for obesity among Ob. The Ob cohort had 2-5× higher rates of cardiopulmonary and metabolic complications (P < .001), greater pharmacologic burden, length of stay (LOS, 225 vs 89 hours, P < .001) and stay in intensive care but no differences in the prevalence of mental disorders. Compared with BMI <35 kg/m2 , inpatients with BMI >35 kg/m2 were 5× more likely to require intensive care (OR 5.08 [1.43-27.3, 95% CI], P = .0047). The initiation of obesity-specific interventions by clinical teams was very low. People with obesity who are admitted to hospital carry significant cost and complications, yet obesity is seldom recognized as a clinical entity or contributor.
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Affiliation(s)
- Ramy H Bishay
- Metabolic and Weight Loss Program, Department of Endocrinology and Diabetes, Blacktown Hospital, Western Sydney Local Health District, Sydney, New South Wales, Australia
- School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
- Western Sydney Diabetes, Integrated and Community Health Directorate, Blacktown Hospital Department of Endocrinology and Diabetes, Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - G Meyerowitz-Katz
- Western Sydney Diabetes, Integrated and Community Health Directorate, Blacktown Hospital Department of Endocrinology and Diabetes, Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - T M Hng
- Metabolic and Weight Loss Program, Department of Endocrinology and Diabetes, Blacktown Hospital, Western Sydney Local Health District, Sydney, New South Wales, Australia
- School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - C M G Colaco
- Department of Medicine, Blacktown Hospital, Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - S Khanna
- Department of Medicine, Blacktown Hospital, Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - R Klein
- Department of Medicine, Blacktown Hospital, Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - D Sanjeev
- Metabolic and Weight Loss Program, Department of Endocrinology and Diabetes, Blacktown Hospital, Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - M McLean
- Metabolic and Weight Loss Program, Department of Endocrinology and Diabetes, Blacktown Hospital, Western Sydney Local Health District, Sydney, New South Wales, Australia
- School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
- Western Sydney Diabetes, Integrated and Community Health Directorate, Blacktown Hospital Department of Endocrinology and Diabetes, Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - G Ahlenstiel
- Metabolic and Weight Loss Program, Department of Endocrinology and Diabetes, Blacktown Hospital, Western Sydney Local Health District, Sydney, New South Wales, Australia
- School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
- Department of Medicine, Blacktown Hospital, Western Sydney Local Health District, Sydney, New South Wales, Australia
- Storr Liver Centre, Westmead Millennium Institute, University of Sydney, Sydney, New South Wales, Australia
| | - G F Maberly
- School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
- Western Sydney Diabetes, Integrated and Community Health Directorate, Blacktown Hospital Department of Endocrinology and Diabetes, Western Sydney Local Health District, Sydney, New South Wales, Australia
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19
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Sewter R, Heaney S, Patterson A. Coffee Consumption and the Progression of NAFLD: A Systematic Review. Nutrients 2021; 13:2381. [PMID: 34371891 PMCID: PMC8308484 DOI: 10.3390/nu13072381] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/01/2021] [Accepted: 07/06/2021] [Indexed: 11/23/2022] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver disease in developed countries. Coffee is one of the most consumed beverages in the world and has been shown to be beneficial in limiting progression in chronic liver disease in general. However, research surrounding the impact of coffee consumption on NAFLD progression is limited. This systematic review aimed to investigate the relationship between coffee consumption and the progression of liver disease, specifically for cases of NAFLD. MEDLINE, EMBASE, CINAHL, the Cochrane Library, and Scopus were searched for published studies that evaluated the effects of coffee consumption on the progression of NAFLD. The results are presented in a narrative synthesis with principal summary measures, including odds ratios, p-values, and differences in mean coffee intake in relation to severity of NAFLD. Five studies met the inclusion criteria and were included in this review. There was no trial evidence among NAFLD patients, rather all studies were of a cross-sectional design. Using the Academy of Nutrition and Dietetics Quality Criteria Checklist, four studies received a positive rating, with the remaining study receiving a neutral rating. Overall, four out of the five studies reported a statistically significant relationship between coffee consumption and the severity of fibrosis. Methods around capturing and defining coffee consumption were heterogeneous and therefore an effective dose could not be elucidated. Results suggest that higher coffee consumption is inversely associated with the severity of hepatic fibrosis in individuals with NAFLD. However, further research is required to elucidate the optimum quantity and form/preparation of coffee required to exert this hepatoprotective role.
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Affiliation(s)
- Rebecca Sewter
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia; (R.S.); (S.H.)
| | - Susan Heaney
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia; (R.S.); (S.H.)
- Department of Rural Health, College of Health, Medicine and Wellbeing, University of Newcastle, Port Macquarie, NSW 2444, Australia
| | - Amanda Patterson
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia; (R.S.); (S.H.)
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia
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20
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Gracen L, Powell EE. Non-alcoholic fatty liver disease: raising awareness of a looming public health problem. Med J Aust 2021; 215:75-76. [PMID: 34046909 DOI: 10.5694/mja2.51109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Lucy Gracen
- Centre for Liver Disease Research, Translational Research Institute Australia, University of Queensland, Brisbane, QLD.,Princess Alexandra Hospital, Brisbane, QLD
| | - Elizabeth E Powell
- Centre for Liver Disease Research, Translational Research Institute Australia, University of Queensland, Brisbane, QLD.,Princess Alexandra Hospital, Brisbane, QLD
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21
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Roberts SK, Majeed A, Glenister K, Magliano D, Lubel JS, Bourke L, Simmons D, Kemp WW. Prevalence of non-alcoholic fatty liver disease in regional Victoria: a prospective population-based study. Med J Aust 2021; 215:77-82. [PMID: 34028830 DOI: 10.5694/mja2.51096] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 02/15/2021] [Accepted: 02/15/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To investigate the prevalence of non-alcoholic fatty liver disease (NAFLD) and its risk factors in regional Victoria. DESIGN Prospective cross-sectional observational study (sub-study to CrossRoads II health study in Shepparton and Mooroopna). SETTING Four towns (populations, 6300-49 800) in the Goulburn Valley of Victoria. PARTICIPANTS Randomly selected from households selected from residential address lists provided by local government organisations for participation in the CrossRoads II study. MAIN OUTCOME MEASURES Age- and sex-adjusted estimates of NAFLD prevalence, defined by a fatty liver index score of 60 or more in people without excessive alcohol intake or viral hepatitis. RESULTS A total of 705 invited adults completed all required clinical, laboratory and questionnaire evaluations of alcohol use (participation rate, 37%); 392 were women (56%), and their mean age was 59.1 years (SD, 16.1 years). Of the 705 participants, 274 met the fatty liver index criterion for NAFLD (crude prevalence, 38.9%; age- and sex-standardised prevalence, 35.7%). The mean age of participants with NAFLD (61 years; SD, 15 years) was higher than for those without NAFLD (58 years; SD, 16 years); a larger proportion of people with NAFLD were men (50% v 41%). Metabolic risk factors more frequent among participants with NAFLD included obesity (69% v 15%), hypertension (66% v 48%), diabetes (19% v 8%), and dyslipidaemia (63% v 33%). Mean serum alanine aminotransferase levels were higher (29 U/L; SD, 17 U/L v 24 U/L; SD, 14 U/L) and mean median liver stiffness greater (6.5 kPa; SD, 5.6 kPa v 5.3kPa; SD, 2.0 kPa) in participants with NAFLD. CONCLUSION The prevalence of NAFLD among adults in regional Victoria is high. Metabolic risk factors are more common among people with NAFLD, as are elevated markers of liver injury.
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Affiliation(s)
- Stuart K Roberts
- Alfred Health, Melbourne, VIC.,Monash University, Melbourne, VIC
| | - Ammar Majeed
- Alfred Health, Melbourne, VIC.,Monash University, Melbourne, VIC
| | | | | | - John S Lubel
- Alfred Health, Melbourne, VIC.,Monash University, Melbourne, VIC
| | | | - David Simmons
- Macarthur Clinical School, Western Sydney University, Sydney, NSW
| | - William W Kemp
- Alfred Health, Melbourne, VIC.,Monash University, Melbourne, VIC
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22
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Huang TD, Behary J, Zekry A. Non-alcoholic fatty liver disease: a review of epidemiology, risk factors, diagnosis and management. Intern Med J 2021; 50:1038-1047. [PMID: 31760676 DOI: 10.1111/imj.14709] [Citation(s) in RCA: 133] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 09/14/2019] [Accepted: 10/15/2019] [Indexed: 12/13/2022]
Abstract
Due to the rising prevalence of obesity and type II diabetes mellitus, non-alcoholic fatty liver disease is becoming the leading cause of chronic liver disease in the Western world. In some patients, simple steatosis can result in non-alcoholic steatohepatitis which over time can lead to liver cirrhosis and its associated sequelae, including hepatocellular carcinoma. Early identification and management of patients at risk with intensive dietary and lifestyle modification are essential to prevent the development of advanced liver disease and its complications. In this review, we will discuss the epidemiology of non-alcoholic fatty liver disease, pathogenesis, diagnosis, management and surveillance strategies to offset the morbidity and mortality of this disease, as well as liver and non-liver-related complications.
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Affiliation(s)
- Tony Dazhong Huang
- Department of Gastroenterology and Hepatology, St George Hospital, Sydney, New South Wales, Australia.,St George and Sutherland Clinical School, UNSW Sydney, Sydney, New South Wales, Australia
| | - Jason Behary
- Department of Gastroenterology and Hepatology, St George Hospital, Sydney, New South Wales, Australia.,St George and Sutherland Clinical School, UNSW Sydney, Sydney, New South Wales, Australia
| | - Amany Zekry
- Department of Gastroenterology and Hepatology, St George Hospital, Sydney, New South Wales, Australia.,St George and Sutherland Clinical School, UNSW Sydney, Sydney, New South Wales, Australia
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Gao Y, Zhang J, Xiao X, Ren Y, Yan X, Yue J, Wang T, Wu Z, Lv Y, Wu R. The Role of Gut Microbiota in Duodenal-Jejunal Bypass Surgery-Induced Improvement of Hepatic Steatosis in HFD-Fed Rats. Front Cell Infect Microbiol 2021; 11:640448. [PMID: 33869077 PMCID: PMC8050338 DOI: 10.3389/fcimb.2021.640448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 03/16/2021] [Indexed: 12/12/2022] Open
Abstract
Bariatric surgery including duodenal-jejunal bypass surgery (DJB) improves insulin sensitivity and reduces obesity-associated inflammation. However, the underlying mechanism for such an improvement is still incompletely understood. Our objective was to investigate the role of the gut microbiota in DJB-associated improvement of hepatic steatosis in high fat diet (HFD)-fed rats. To study this, hepatic steatosis was induced in male adult Sprague-Dawley rats by feeding them with a 60% HFD. At 8 weeks after HFD feeding, the rats were subjected to either DJB or sham operation. HFD was resumed 1 week after the surgery for 3 more weeks. In additional groups of animals, feces were collected from HFD-DJB rats at 2 weeks after DJB. These feces were then transplanted to HFD-fed rats without DJB at 8 weeks after HFD feeding. Hepatic steatosis and fecal microbiota were analyzed at 4 weeks after surgery or fecal transplantation. Our results showed that DJB alleviated hepatic steatosis in HFD-fed rats. Fecal microbiota analysis showed that HFD-fed and standard diet-fed rats clustered differently. DJB induced substantial compositional changes in the gut microbiota. The fecal microbiota of HFD-fed rats received fecal transplant from DJB rats overlapped with that of HFD-DJB rats. Treatment of rats with HFD-induced liver lesions by fecal transplant from DJB-operated HFD-fed rats also attenuated hepatic steatosis. Thus, alterations in the gut microbiota after DJB surgery are sufficient to attenuate hepatic steatosis in HFD-fed rats. Targeting the gut microbiota could be a promising approach for preventing or treating human NAFLD.
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Affiliation(s)
- Yi Gao
- National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- Gastrointestinal Surgery Department, Affiliated Hospital of Guilin Medical University, Guilin, China
| | - Jia Zhang
- National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Xiao Xiao
- School of Basic Medicine, Hubei University of Medicine, Shiyan, China
| | - Yifan Ren
- National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Xiaopeng Yan
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Jing Yue
- Gastrointestinal Surgery Department, Affiliated Hospital of Guilin Medical University, Guilin, China
- School of Basic Medicine, Hubei University of Medicine, Shiyan, China
| | - Tieyan Wang
- Department of Pathology, Shiyan Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Zheng Wu
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Yi Lv
- National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Rongqian Wu
- National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
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24
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Hayward KL, Johnson AL, Horsfall LU, Moser C, Valery PC, Powell EE. Detecting non-alcoholic fatty liver disease and risk factors in health databases: accuracy and limitations of the ICD-10-AM. BMJ Open Gastroenterol 2021; 8:bmjgast-2020-000572. [PMID: 33568418 PMCID: PMC7878135 DOI: 10.1136/bmjgast-2020-000572] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 12/22/2020] [Accepted: 01/06/2021] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE The prevalence of non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) cirrhosis is often underestimated in healthcare and administrative databases that define disease burden using International Classification of Diseases (ICD) codes. This retrospective audit was conducted to explore the accuracy and limitations of the ICD, Tenth Revision, Australian Modification (ICD-10-AM) to detect NAFLD, metabolic risk factors (obesity and diabetes) and other aetiologies of chronic liver disease. DESIGN/METHOD ICD-10-AM codes in 308 admitted patient encounters at two major Australian tertiary hospitals were compared with data abstracted from patients' electronic medical records. Accuracy of individual codes and grouped combinations was determined by calculating sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and Cohen's kappa coefficient (κ). RESULTS The presence of an ICD-10-AM code accurately predicted the presence of NAFLD/NASH (PPV 91.2%) and obesity (PPV 91.6%) in most instances. However, codes underestimated the prevalence of NAFLD/NASH and obesity by 42.9% and 45.3%, respectively. Overall concordance between clinical documentation and 'grouped alcohol' codes (κ 0.75) and hepatitis C codes (κ 0.88) was high. Hepatitis B codes detected false-positive cases in patients with previous exposure (PPV 55.6%). Accuracy of codes to detect diabetes was excellent (sensitivity 95.8%; specificity 97.6%; PPV 94.9%; NPV 98.1%) with almost perfect concordance between codes and documentation in medical records (κ 0.93). CONCLUSION Recognition of the utility and limitations of ICD-10-AM codes to study the burden of NAFLD/NASH cirrhosis is imperative to inform public health strategies and appropriate investment of resources to manage this burgeoning chronic disease.
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Affiliation(s)
- Kelly Lee Hayward
- Centre for Liver Disease Research, The University of Queensland, Woolloongabba, Queensland, Australia.,Princess Alexandra Hospital, Metro South Hospital and Health Service, Woolloongabba, Queensland, Australia
| | - Amy L Johnson
- Centre for Liver Disease Research, The University of Queensland, Woolloongabba, Queensland, Australia.,Princess Alexandra Hospital, Metro South Hospital and Health Service, Woolloongabba, Queensland, Australia
| | - Leigh U Horsfall
- Centre for Liver Disease Research, The University of Queensland, Woolloongabba, Queensland, Australia.,Princess Alexandra Hospital, Metro South Hospital and Health Service, Woolloongabba, Queensland, Australia
| | - Chris Moser
- Statistical Services Branch, Queensland Government Department of Health and Ageing, Brisbane, Queensland, Australia
| | - Patricia C Valery
- Centre for Liver Disease Research, The University of Queensland, Woolloongabba, Queensland, Australia.,QIMR Berghofer Medical Research Institute, Population Health, Herston, Queensland, Australia
| | - Elizabeth E Powell
- Centre for Liver Disease Research, The University of Queensland, Woolloongabba, Queensland, Australia .,Princess Alexandra Hospital, Metro South Hospital and Health Service, Woolloongabba, Queensland, Australia
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25
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Majumdar A, Tsochatzis EA. Changing trends of liver transplantation and mortality from non-alcoholic fatty liver disease. Metabolism 2020; 111S:154291. [PMID: 32531295 DOI: 10.1016/j.metabol.2020.154291] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 05/18/2020] [Accepted: 06/08/2020] [Indexed: 02/06/2023]
Abstract
The rising tide of non-alcoholic fatty liver disease (NAFLD) associated with the obesity epidemic is a major international health concern. NAFLD is the leading global cause of liver disease with an estimated prevalence of 25% and is the fastest growing indication for liver transplantation (LT). The presence and severity of liver fibrosis is the only histologic predictor of clinical outcomes in this group. NAFLD poses several challenges in the peri-transplant setting including the management of multiple metabolic co-morbidities, post-transplant obesity and cardiovascular risk. However, post-LT outcomes in well-selected NAFLD patients appear similar to non-NAFLD indications, including in the setting of hepatocellular carcinoma (HCC). The rising prevalence of NAFLD may impact potential liver graft donors, which may in-turn adversely affect post-LT outcomes. This review outlines the current epidemiology, natural history and outcomes of NAFLD with a focus on pre- and post-liver transplant settings.
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Affiliation(s)
- Avik Majumdar
- AW Morrow Gastroenterology and Liver Centre, Australian National Liver Transplant Unit, Royal Prince Alfred Hospital, Sydney, Australia; Central Clinical School, The University of Sydney, Australia
| | - Emmanuel A Tsochatzis
- UCL Institute for Liver and Digestive Health, Royal Free Hospital and UCL, London, UK; Sheila Sherlock Liver Centre, Royal Free Hospital, London, UK.
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26
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Accuracy of a Semi-Quantitative Ultrasound Method to Determine Liver Fat Infiltration in Early Adulthood. Diagnostics (Basel) 2020; 10:diagnostics10060431. [PMID: 32630407 PMCID: PMC7345476 DOI: 10.3390/diagnostics10060431] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 06/11/2020] [Accepted: 06/15/2020] [Indexed: 12/17/2022] Open
Abstract
An inexpensive and simple method to determine non-alcoholic fatty liver disease (NAFLD) is the abdominal ultrasound, but there are still doubts about its accuracy. We assessed the precision of a semi-quantitative ultrasound method to determine liver fat infiltration, using magnetic resonance spectroscopy (MRS) as the reference. The study was conducted in youths from an ongoing cohort study. Clinical validation was performed, using receiver operating characteristic analysis, in n = 60 participants (22.6y; 50% males). Abdominal ultrasound was carried out with liver brightness (score 0-3), diaphragm attenuation (0-2) and liver vessel blurring (0-1) scored by two observers. Liver fat was estimated using MRS. Then, analytical validation was conducted in the remaining participants (n = 555; 22.7y; 51% males) using effects size estimates. An ultrasound score ≥4.0 had the highest sensitivity (78%) and specificity (85%) for NAFLD diagnosis. An area under the curve of 86% denotes a good diagnostic performance of the test, whereas a Kappa of 0.63 suggests substantial agreement of ultrasound vs. MRS. The analytical validation showed that participants having NAFLD according to ultrasound had an unhealthier cardiometabolic profile than participants without the condition. Abdominal ultrasound, combined with a semi-quantitative score system, is a reliable method to determine liver fat infiltration in young adults and should be encouraged whenever MRS is unavailable.
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27
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Development and validation of a clinical and laboratory-based nomogram to predict nonalcoholic fatty liver disease. Hepatol Int 2020; 14:808-816. [PMID: 32572817 DOI: 10.1007/s12072-020-10065-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 06/06/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIM Nonalcoholic fatty liver disease (NAFLD) is becoming the leading cause of chronic liver disease in China. The early identification and management of patients at risk are essential. We aimed to develop a novel clinical and laboratory-based nomogram (CLN) model to predict NAFLD with high accuracy. METHODS We designed a retrospective cross-sectional study and enrolled 21,468 participants (16,468 testing and 5000 validation). Clinical information and laboratory/imaging results were retrieved. Significant variables independently associated with NAFLD were identified by a logistic regression model, and a NAFLD prediction CLN was constructed. The CLN was then compared with four existing NAFLD-related prediction models: the fatty liver index (FLI), the hepatic steatosis index (HSI), the visceral adiposity index (VAI) and the triglycerides and glucose (TyG) index. Area under the receiver operator characteristic curve (AUROC) and decision curve analysis (DCA) were performed. RESULTS A total of 6261/16,468 (38.02%) and 1759/5000 (35.18%) participants in the testing and validation datasets, respectively, had ultrasound-proven NAFLD. Six variables were selected to build the CLN: body mass index (BMI), diastolic blood pressure (DBP), uric acid (UA), fasting blood glucose (FBG), triglyceride (TG), and alanine aminotransferase (ALT). The diagnostic accuracy of the CLN for NAFLD (AUROC 0.857, 95% CI 0.852-0.863) was significantly superior to that of the FLI (AUROC 0.849, 95% CI 0.843-0.855), the VAI (AUROC 0.752, 95% CI 0.745-0.760), the HSI (AUROC 0.828, 95% CI 0.822-0.834), and the TyG index (AUROC 0.774, 95% CI 0.767-0.781) (all p < 0.001). DCA confirmed the clinical utility of the CLN. CONCLUSIONS This physical examination and laboratory test-based, nonimage-assisted novel nomogram has better performance in predicting NAFLD than the FLI, the VAI, the HSI and the TyG index alone. This model can be used as a quick screening tool to assess NAFLD in the general population.
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28
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Nguyen TH, Wardell R, Chitturi S, Teoh N, Farrell G. When the liver gets stiff, the tough get moving. J Gastroenterol Hepatol 2020; 35:953-959. [PMID: 31867782 DOI: 10.1111/jgh.14963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 12/20/2019] [Indexed: 12/30/2022]
Abstract
Liver stiffness measurement (LSM) by FibroScan-determined transient elastography is a noninvasive approach to estimate liver fibrosis severity. In non-alcoholic fatty liver disease (NAFLD), advanced liver fibrosis is excluded by normal liver stiffness, but a wide range of cutoffs have been used to predict advanced liver fibrosis or cirrhosis. This may be partly because steatosis (measured by controlled attenuation parameter [CAP]) contributes to liver stiffness and also because LSM fluctuates in NAFLD. In a recent pivotal study, one-third of patients with liver stiffness > 12.0 kPa showed reversal after 4-6 months; these cases did not have advanced liver fibrosis on biopsy. We performed serial FibroScans 6-36 months apart in 73 NAFLD patients, 38 with LSM > 10 kPa at entry. Those who lost ≥ 1 kg of weight (n = 31) significantly reduced liver stiffness (3.6 ± 6.1 vs 0.53 ± 4.1 kPa, P < 0.05) and CAP score (39 ± 63 dB/m of loss vs 24 ± 65 dB/m of gain, P < 0.05) compared with those who did not (n = 29). Patients who reported increased physical activity (n = 25) also reduced liver stiffness (3.6 ± 6 vs 0.35 ± 6 kPa) and CAP (20 ± 71 dB/m of loss vs 32 ± 71 dB/m of gain). Overall, those with improved LSM were significantly more likely to have lost weight and/or improved physical activity. These effects of lifestyle adjustments partly explain why a single measurement of 12.0 kPa is not a reliable cutoff for advanced liver fibrosis in NAFLD. In addition to repeating the study after 6-12 months, documentation of response to lifestyle advice and weight reduction should be determined before assuming any cutoff indicates advanced liver fibrosis. Despite this reservation about diagnostic accuracy, we consider that measurement of liver stiffness and CAP score serve to motivate patients to enact lifestyle modifications that can improve NAFLD severity.
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Affiliation(s)
- Thuy-Huong Nguyen
- Gastroenterology and Hepatology Unit, Canberra Hospital and Australian National University Medical School, Canberra, Australian Capital Territory, Australia
| | - Rebecca Wardell
- Gastroenterology and Hepatology Unit, Canberra Hospital and Australian National University Medical School, Canberra, Australian Capital Territory, Australia
| | - Shiv Chitturi
- Gastroenterology and Hepatology Unit, Canberra Hospital and Australian National University Medical School, Canberra, Australian Capital Territory, Australia
| | - Narci Teoh
- Gastroenterology and Hepatology Unit, Canberra Hospital and Australian National University Medical School, Canberra, Australian Capital Territory, Australia
| | - Geoff Farrell
- Gastroenterology and Hepatology Unit, Canberra Hospital and Australian National University Medical School, Canberra, Australian Capital Territory, Australia
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29
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McSweeney L, Breckons M, Fattakhova G, Oluboyede Y, Vale L, Ternent L, Balp MM, Doward L, Brass CA, Beyer F, Sanyal A, Anstee QM. Health-related quality of life and patient-reported outcome measures in NASH-related cirrhosis. JHEP Rep 2020; 2:100099. [PMID: 32435754 PMCID: PMC7229498 DOI: 10.1016/j.jhepr.2020.100099] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 02/04/2020] [Accepted: 02/22/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND & AIMS Non-alcoholic steatohepatitis (NASH) is known to have a negative impact on patients' health-related quality of life (HRQoL), even before progression to cirrhosis has occurred. The burden of NASH-related cirrhosis from the patient perspective remains poorly understood. Herein, we aimed to identify the burden of disease and HRQoL impairment among patients with NASH-related compensated cirrhosis. METHODS This targeted literature review sought first to identify the humanistic burden of disease from the perspective of patients with diagnosed NASH-cirrhosis and, secondly, to identify generic or disease-specific patient-reported outcome measures (PROMs) used to assess the impact of NASH-cirrhosis. Searches were conducted in bibliographical databases, grey or unpublished literature, liver disease websites, support group websites and online blogs. A quality assessment of specific PROMs was conducted. RESULTS Patients with NASH-cirrhosis are reported to suffer from lower HRQoL than patients with non-cirrhotic NASH and the general population with respect to physical health/functioning, emotional health and worry, and mental health. Thirteen PROMs were identified, of which 4 were liver-disease specific: CLDQ, CLDQ-NAFLD, LDQoL and LDSI. The most commonly used measures do not comply with current industry or regulatory standards for PROMs and/or are not validated for use in a cirrhotic NASH population. CONCLUSIONS Patients with NASH-cirrhosis have lower HRQoL and poorer physical health than patients with non-cirrhotic NASH. However, the literature lacked detail of the everyday impact on patients' lives. Currently, a number of PROMs are available to measure the impact of the disease in patients with chronic liver conditions. The lack of studies that include qualitative insights in this population mandates further exploration and research. LAY SUMMARY It is not well understood how having non-alcoholic fatty liver disease (NAFLD)-related cirrhosis affects a person's everyday wellbeing and quality of life. Some research has been done with patients who have early stages of liver disease but not people with cirrhosis. We found that patients with NAFLD-related cirrhosis tended to have poorer health than patients without cirrhosis. But there was not very much information from patients themselves and there were no tools or questionnaires just for this group of patients.
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Key Words
- CLDQ, chronic liver disease questionnaire
- COSMIN, The COnsensus-based Standards for the selection of health Measurement INstruments
- Cirrhosis
- EMA, European Medicines Agency
- FDA, United States Food and Drug Administration
- FIS, fatigue impact scale
- HRQoL, health-related quality of life
- LDQoL, liver disease quality of life questionnaire
- LDSI, liver disease symptom index
- MS, multiple sclerosis
- NAFL, non-alcoholic fatty liver
- NAFLD
- NAFLD, non-alcoholic fatty liver disease
- NASH, non-alcoholic steatohepatitis
- Non-alcoholic steatohepatitis
- PHAQ, patient-reported outcome measurement information system health assessment questionnaire
- PRO, patient-reported outcome
- PROM, patient-reported outcome measure
- QoL, quality of life
- RI, researcher interpretation
- SF-36, short form health profile 36
- health-related quality of life
- liver
- patient-reported outcome measures
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Affiliation(s)
- Lorraine McSweeney
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Matthew Breckons
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Gulnar Fattakhova
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Yemi Oluboyede
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Luke Vale
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Laura Ternent
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | | | - Lynda Doward
- RTI-Health Solutions, The Pavilion, Towers Business Park, Wilmslow Road, Didsbury, Manchester, UK
| | | | - Fiona Beyer
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Arun Sanyal
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, United States
| | - Quentin M. Anstee
- Translational & Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK & Newcastle NIHR Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK
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30
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Brain D, O'Beirne J, Hickman IJ, Powell EE, Valery PC, Kularatna S, Tulleners R, Farrington A, Horsfall L, Barnett A. Protocol for a randomised trial testing a community fibrosis assessment service for patients with suspected non-alcoholic fatty liver disease: LOCal assessment and triage evaluation of non-alcoholic fatty liver disease (LOCATE-NAFLD). BMC Health Serv Res 2020; 20:335. [PMID: 32316984 PMCID: PMC7171744 DOI: 10.1186/s12913-020-05233-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 04/15/2020] [Indexed: 12/24/2022] Open
Abstract
Background Non-alcoholic fatty liver disease (NAFLD) is the most common type of chronic liver disease in Australia and its recent increase mirrors the obesity and type 2 diabetes epidemics. Currently, many patients who present to primary care with abnormal liver function tests or steatosis on liver ultrasound are referred for assessment in secondary care. Due to the large number of patients with NAFLD, this results in long waits for clinical and fibrosis assessment, placing unnecessary burden on the public hospital system. Methods We will conduct a 1:1 parallel randomised trial to compare two alternative models of care for NAFLD. Participants will be randomised to usual care or the LOCal Assessment and Triage Evaluation (LOCATE) model of care and followed for 1 year. We will recruit patients from the non-neighbouring Sunshine Coast and Metro South Hospital and Health Services (HHSs) in Queensland, Australia. Our primary outcome of interest is time to diagnosis of high-risk NAFLD, based on the number of participants in each arm of the study who receive a diagnosis of clinically significant fibrosis. Two hundred and 34 participants will give us a 95% power to detect a 50% reduction in the primary outcome of time to diagnosis of high-risk disease. We will also conduct an economic evaluation, evaluating the cost-effectiveness of the new model of care. We will also evaluate the implementation of the new model of care. Discussion It is anticipated that the results of this study will provide valuable new information regarding the management of NAFLD in the Australian setting. A relatively simple change to care could result in earlier identification of patients with significant liver disease and lower overall costs for the health system. Results will be directly disseminated to key staff for further distribution to consumers, policy- and decision-makers in the form of evidence briefs, plain language summaries and policy recommendations. Trial registration The trial was registered on 30 January, 2020 and can be found via ANZCTR - number ACTRN12620000158965.
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Affiliation(s)
- David Brain
- Australian Centre for Health Services Innovation (AusHSI), Queensland University of Technology, GPO Box 2434, Brisbane, QLD, 4001, Australia.
| | - James O'Beirne
- University of the Sunshine Coast, Locked bag 4, Maroochydore DC, QLD, 4558, Australia
| | - Ingrid J Hickman
- The University of Queensland, St Lucia, QLD, 4072, Australia.,Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, QLD, 4102, Australia
| | - Elizabeth E Powell
- Centre for Liver Disease Research, Faculty of Medicine, Translational Research Institute, The University of Queensland, Brisbane, QLD, Australia.,Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD, 4102, Australia
| | - Patricia C Valery
- QIMR Berghofer Medical Research Institute, Locked bag 2000, Royal Brisbane Hospital, QLD, 4029, Australia
| | - Sanjeewa Kularatna
- Australian Centre for Health Services Innovation (AusHSI), Queensland University of Technology, GPO Box 2434, Brisbane, QLD, 4001, Australia
| | - Ruth Tulleners
- Australian Centre for Health Services Innovation (AusHSI), Queensland University of Technology, GPO Box 2434, Brisbane, QLD, 4001, Australia
| | - Alison Farrington
- Australian Centre for Health Services Innovation (AusHSI), Queensland University of Technology, GPO Box 2434, Brisbane, QLD, 4001, Australia
| | - Leigh Horsfall
- The University of Queensland, St Lucia, QLD, 4072, Australia
| | - Adrian Barnett
- Australian Centre for Health Services Innovation (AusHSI), Queensland University of Technology, GPO Box 2434, Brisbane, QLD, 4001, Australia
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Teeratorn N, Piyachaturawat P, Thanapirom K, Chaiteerakij R, Sonsiri K, Komolmit P, Tangkijvanich P, Rerknimitr R, Adams L, Treeprasertsuk S. Screening for non-alcoholic fatty liver disease in community setting: A cohort study using controlled attenuation parameter-transient elastography. JGH Open 2020; 4:245-250. [PMID: 32280772 PMCID: PMC7144791 DOI: 10.1002/jgh3.12252] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 07/23/2019] [Accepted: 08/16/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND/AIM The global problems of chronic liver disease and non-alcoholic fatty liver disease (NAFLD) are increasing. We examined the prevalence of NAFLD and significant liver stiffness in an asymptomatic population and identified the predictors of significant fibrosis in NAFLD. METHOD We prospectively enrolled Thai subjects, aged 18-80 years, from four regions (Bangkok, Central, North, South) of Thailand from March 2013 to November 2016. All participants underwent controlled attenuation parameter (CAP) measurement for liver fat quantification and transient elastography (TE) for liver stiffness measurement (LSM). NAFLD was defined as liver fat ≥10% (CAP ≥ 306 dB/m). Of 1145 participants, 782 (68.3%) were eligible for analysis. RESULT The mean age ± standard deviation (SD) was 53.1 ± 4.6 years, and 71.6% were female. The mean ± SD values of CAP and LSM of the overall cohort were 241.9 ± 61.4 dB/m and 5.5 ± 3.8 kPa, respectively. The prevalence of NAFLD was 18.0%, whereas 5.4% of the cohort had nonobese NAFLD (BMI < 25 kg/m2), and 2.8% had lean NAFLD (BMI < 23 kg/m2). The prevalence of significant liver fibrosis (≥F2) in NAFLD subjects was 18.4%. On multivariate analysis, the degree of significant fibrosis in NAFLD was significantly associated with male gender and a history of dyslipidemia. CONCLUSION NAFLD with significant fibrosis (≥F2) is prevalent in asymptomatic populations. The predictors of significant fibrosis in NAFLD were male gender and dyslipidemia. Screening for NAFLD using CAP/TE in asymptomatic populations should be considered in hospitals with available facilities.
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Affiliation(s)
- Nicha Teeratorn
- Department of Medicine, Division of Gastroenterology, Faculty of MedicineChulalongkorn UniversityBangkokThailand
- Thai Red Cross SocietyBangkokThailand
- Department of MedicineBuddhachinaraj HospitalPhitsanulokThailand
| | - Panida Piyachaturawat
- Department of Medicine, Division of Gastroenterology, Faculty of MedicineChulalongkorn UniversityBangkokThailand
- Thai Red Cross SocietyBangkokThailand
| | - Kessarin Thanapirom
- Department of Medicine, Division of Gastroenterology, Faculty of MedicineChulalongkorn UniversityBangkokThailand
- Thai Red Cross SocietyBangkokThailand
| | - Roongruedee Chaiteerakij
- Department of Medicine, Division of Gastroenterology, Faculty of MedicineChulalongkorn UniversityBangkokThailand
- Thai Red Cross SocietyBangkokThailand
| | - Kanokwan Sonsiri
- Department of Medicine, Division of Gastroenterology, Faculty of MedicineChulalongkorn UniversityBangkokThailand
- Thai Red Cross SocietyBangkokThailand
| | - Piyawat Komolmit
- Department of Medicine, Division of Gastroenterology, Faculty of MedicineChulalongkorn UniversityBangkokThailand
- Thai Red Cross SocietyBangkokThailand
| | - Pisit Tangkijvanich
- Thai Red Cross SocietyBangkokThailand
- Department of Biochemistry and Liver Research Unit, Faculty of MedicineChulalongkorn UniversityBangkokThailand
| | - Rungsun Rerknimitr
- Department of Medicine, Division of Gastroenterology, Faculty of MedicineChulalongkorn UniversityBangkokThailand
- Thai Red Cross SocietyBangkokThailand
| | - Leon Adams
- Medical SchoolUniversity of Western AustraliaNedlandsWestern AustraliaAustralia
| | - Sombat Treeprasertsuk
- Department of Medicine, Division of Gastroenterology, Faculty of MedicineChulalongkorn UniversityBangkokThailand
- Thai Red Cross SocietyBangkokThailand
- Department of Biochemistry and Liver Research Unit, Faculty of MedicineChulalongkorn UniversityBangkokThailand
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32
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Magdaleno-Tapial J, Valenzuela-Oñate C, Ortiz-Salvador JM, Martínez-Doménech Á, García-Legaz-Martínez M, Alonso-Carpio M, Tamarit-García JJ, Diago-Madrid M, Sánchez-Carazo JL, Pérez-Ferriols A. Prevalence of non-alcoholic fatty liver and liver fibrosis in patients with moderate-severe psoriasis: A cross-sectional cohort study. Australas J Dermatol 2019; 61:105-109. [PMID: 31731325 DOI: 10.1111/ajd.13175] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND/OBJECTIVES Several studies have reported that non-alcoholic fatty liver disease (NAFLD) is more frequent in patients with psoriasis, but few have reviewed the presence of liver fibrosis in those patients. METHODS Cross-sectional cohort, single-centre study, continuously selecting all patients with moderate-severe psoriasis seen at the Psoriasis Unit of a Tertiary Hospital. The grade of liver steatosis was assessed using liver ultrasound, and the quantity of liver fibrosis was graded using a transitional vibration-controlled elastography (Fibroscan®). RESULTS A total of 71 patients (66.2% male) were included, with an average age of 46.6 years old. The maximum historical PASI average was 14.4 while the baseline PASI average at the time of the study was 2. A third (36%) of patients met the criteria for metabolic syndrome 52% of patients had steatosis; being male, having metabolic syndrome comorbidities, elevated AST/ALT enzymes, dyslipidemia and high initial PASI were significantly related. 14% of patients had moderate liver fibrosis (≥7.6 KPa). In 30% of them, no ultrasound liver steatosis was observed. CONCLUSIONS Elastography may be a useful tool along with ultrasound to evaluate liver disease in patients with psoriasis.
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Affiliation(s)
| | | | | | | | | | - Miriam Alonso-Carpio
- Department of Dermatology, Hospital General Universitario de Valencia, Valencia, Spain
| | | | - Moisés Diago-Madrid
- Department of Gastroenterology and Hepatology, Hospital General Universitario de Valencia, Valencia, Spain
| | | | - Amparo Pérez-Ferriols
- Department of Dermatology, Hospital General Universitario de Valencia, Valencia, Spain
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33
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Younossi ZM, Golabi P, de Avila L, Paik JM, Srishord M, Fukui N, Qiu Y, Burns L, Afendy A, Nader F. The global epidemiology of NAFLD and NASH in patients with type 2 diabetes: A systematic review and meta-analysis. J Hepatol 2019; 71:793-801. [PMID: 31279902 DOI: 10.1016/j.jhep.2019.06.021] [Citation(s) in RCA: 1438] [Impact Index Per Article: 239.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 06/14/2019] [Accepted: 06/25/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Although non-alcoholic fatty liver disease (NAFLD), non-alcoholic steatohepatitis (NASH) and NASH with advanced fibrosis are closely associated with type 2 diabetes mellitus (T2DM), their global prevalence rates have not been well described. Our aim was to estimate the prevalence of NAFLD, NASH, and advanced fibrosis among patients with T2DM, by regions of the world. METHODS We searched for terms including NAFLD, NASH and T2DM in studies published from January 1989 to September 2018, using PubMed, Ovid MEDLINE®, EMBASE and Web of Science. Strict exclusion criteria were applied. Regional and global mean prevalence weighted by population size in each country were estimated and pooled using random-effects meta-analysis. Potential sources of heterogeneity were investigated using stratified meta-analysis and meta-regression. RESULTS Among 80 studies from 20 countries that met our inclusion criteria, there were 49,419 individuals with T2DM (mean age 58.5 years, mean body mass index 27.9 kg/m2, and males 52.9%). The global prevalence of NAFLD among patients with T2DM was 55.5% (95% CI 47.3-63.7). Studies from Europe reported the highest prevalence (68.0% [62.1-73.0%]). Among 10 studies that estimated the prevalence of NASH, the global prevalence of NASH among individuals with T2DM was 37.3% (95% CI 24.7-50.0%). Seven studies estimated the prevalence of advanced fibrosis in patients with NAFLD and T2DM to be 17.0% (95% CI 7.2-34.8). Meta-regression models showed that geographic region and mean age (p <0.5) were associated with the prevalence of NAFLD, jointly accounting for 63.9% of the heterogeneity. CONCLUSIONS This study provides the global prevalence rates for NAFLD, NASH, and advanced fibrosis in patients with T2DM. These data can be used to estimate the clinical and economic burden of NASH in patients with T2DM around the world. LAY SUMMARY Non-alcoholic fatty liver disease (NAFLD) is now recognized as the most prevalent chronic liver disease worldwide. Type 2 diabetes mellitus (T2DM) is an important risk factor for NAFLD. Additionally, T2DM seems to accelerate the progression of liver disease in NAFLD. Despite the high prevalence and serious clinical implications of NAFLD in patients with T2DM, it is usually overlooked in clinical practice. This meta-analysis provides evidence of the high prevalence of NAFLD and NASH in patients with T2DM. In this context, increasing awareness about the importance of NAFLD in patients with T2DM among all important stakeholders (primary care physicians, specialists, and health policy makers) must be prioritized.
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Affiliation(s)
- Zobair M Younossi
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, United States; Center For Liver Diseases, Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, United States.
| | - Pegah Golabi
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, United States
| | - Leyla de Avila
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, United States
| | - James Minhui Paik
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, United States
| | - Manirath Srishord
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, United States
| | - Natsu Fukui
- Center For Liver Diseases, Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, United States
| | - Ying Qiu
- Bristol-Myers Squibb, Princeton, NJ, United States
| | - Leah Burns
- Bristol-Myers Squibb, Princeton, NJ, United States
| | - Arian Afendy
- Center for Outcomes Research in Liver Disease, Washington DC, United States
| | - Fatema Nader
- Center for Outcomes Research in Liver Disease, Washington DC, United States
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34
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Farrell GC, Wardell R, Teoh N, Chitturi S. Non-alcoholic fatty liver disease. Intern Med J 2019; 49:681-683. [PMID: 31083812 DOI: 10.1111/imj.14283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 02/18/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Geoffrey C Farrell
- Gastroenteorlogy and Hepatology Unit, Canberra Hospital and Australian National University Medical School, Canberra, Australian Capital Territory, Australia
| | - Rebecca Wardell
- Gastroenteorlogy and Hepatology Unit, Canberra Hospital and Australian National University Medical School, Canberra, Australian Capital Territory, Australia
| | - Narci Teoh
- Gastroenteorlogy and Hepatology Unit, Canberra Hospital and Australian National University Medical School, Canberra, Australian Capital Territory, Australia
| | - Shiv Chitturi
- Gastroenteorlogy and Hepatology Unit, Canberra Hospital and Australian National University Medical School, Canberra, Australian Capital Territory, Australia.,Department of Gastroenterology and Hepatology, The Canberra Hospital, Canberra, Australian Capital Territory, Australia
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35
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Gnocchi D, Custodero C, Sabbà C, Mazzocca A. Circadian rhythms: a possible new player in non-alcoholic fatty liver disease pathophysiology. J Mol Med (Berl) 2019; 97:741-759. [PMID: 30953079 DOI: 10.1007/s00109-019-01780-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 03/10/2019] [Accepted: 03/13/2019] [Indexed: 12/16/2022]
Abstract
Over the last decades, a better knowledge of the molecular machinery supervising the regulation of circadian clocks has been achieved, and numerous findings have helped in unravelling the outstanding significance of the molecular clock for the proper regulation of our physiologic and metabolic homeostasis. Non-alcoholic fatty liver disease (NAFLD) is currently considered as one of the emerging liver pathologies in the Western countries due to the modification of eating habits and lifestyle. Although NAFLD is considered a pretty benign condition, it can progress towards non-alcoholic steatohepatitis (NASH) and eventually hepatocellular carcinoma (HCC). The pathogenic mechanisms involved in NAFLD development are complex, since this disease is a multifactorial condition. Major metabolic deregulations along with a genetic background are believed to take part in this process. In this light, the aim of this review is to give a comprehensive description of how our circadian machinery is regulated and to describe to what extent our internal clock is involved in the regulation of hormonal and metabolic homeostasis, and by extension in the development and progression of NAFLD/NASH and eventually in the onset of HCC.
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Affiliation(s)
- Davide Gnocchi
- Interdisciplinary Department of Medicine, University of Bari School of Medicine, Piazza G. Cesare, 11, 70124, Bari, Italy
| | - Carlo Custodero
- Interdisciplinary Department of Medicine, University of Bari School of Medicine, Piazza G. Cesare, 11, 70124, Bari, Italy
| | - Carlo Sabbà
- Interdisciplinary Department of Medicine, University of Bari School of Medicine, Piazza G. Cesare, 11, 70124, Bari, Italy
| | - Antonio Mazzocca
- Interdisciplinary Department of Medicine, University of Bari School of Medicine, Piazza G. Cesare, 11, 70124, Bari, Italy.
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36
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Kutaiba N, Richmond D, Morey M, Brennan D, Rotella JA, Ardalan Z, Goodwin M. Incidental hepatic steatosis on unenhanced computed tomography performed for suspected renal colic: Gaps in reporting and documentation. J Med Imaging Radiat Oncol 2019; 63:431-438. [PMID: 30874372 DOI: 10.1111/1754-9485.12873] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 02/17/2019] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Hepatic steatosis is a common incidental finding on computed tomography (CT) in patients presenting to the emergency department (ED). The aims of our study were to assess the prevalence of hepatic steatosis in ED patients with suspected renal colic and to assess documentation in radiology reports and medical charts correlated with alanine transaminase (ALT) levels. METHODS Over 18 months from January 2016 to June 2017, all unenhanced CTs performed for suspected renal colic were reviewed. Quantitative assessment measuring hepatic and splenic attenuation in Hounsfield Units was performed. Hepatic steatosis was defined using multiple CT criteria including liver/spleen (L/S) ratio. Radiology reports, medical charts and ALT levels, if collected within 24 h of CT, were reviewed. RESULTS A total of 1290 patients were included with a median age 52.5 years (range 16-98) and male predominance (835 [64.7%]). A total of 336 (26%) patients had hepatic steatosis measured by L/S ratio of ≤ 1.0. Ninety-four patients (28%) had radiology reports noting steatosis. Documentation in medical charts was noted in 18 of the 94 patients (19.1%) for whom steatosis was reported. Liver enzymes were available for 704 (54.6%) patients. There was a significantly higher mean ALT level in patients with hepatic steatosis (42.2 U/L; 95% CI 38.4-46.0) compared to patients without (28.8 U/L; 95% CI 25.7-31.9) (P < 0.0001). CONCLUSION Our findings highlight multiple gaps in the reporting and evaluation of hepatic steatosis among radiologists and emergency clinicians alike. Recognising and reporting this incidental finding may impact health outcomes.
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Affiliation(s)
- Numan Kutaiba
- Radiology Department, Austin Health, Melbourne, Victoria, Australia
| | | | - Matthew Morey
- Radiology Department, Austin Health, Melbourne, Victoria, Australia
| | - Daniel Brennan
- Radiology Department, Austin Health, Melbourne, Victoria, Australia
| | - Joe-Anthony Rotella
- Emergency Department, Austin Health, Melbourne, Victoria, Australia.,The University of Melbourne, Melbourne, Victoria, Australia
| | - Zaid Ardalan
- Gastroenterology Department, Austin Health, Melbourne, Victoria, Australia.,Gastroenterology Department, Alfred Health and Monash University, Melbourne, Victoria, Australia
| | - Mark Goodwin
- Radiology Department, Austin Health, Melbourne, Victoria, Australia.,The University of Melbourne, Melbourne, Victoria, Australia
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