Non-alcoholic fatty liver disease and risk of incident acute myocardial infarction and stroke: findings from matched cohort study of 18 million European adults

BMJ, Journal Year: 2019, Volume and Issue: unknown, P. l5367 - l5367

Published: Oct. 8, 2019

To estimate the risk of acute myocardial infarction (AMI) or stroke in adults with non-alcoholic fatty liver disease (NAFLD) steatohepatitis (NASH).Matched cohort study.Population based, electronic primary healthcare databases before 31 December 2015 from four European countries: Italy (n=1 542 672), Netherlands (n=2 225 925), Spain (n=5 488 397), and UK (n=12 695 046).120 795 a recorded diagnosis NAFLD NASH no other diseases, matched at time (index date) by age, sex, practice site, visit, six months after date diagnosis, up to 100 patients without same database.Primary outcome was incident fatal non-fatal AMI ischaemic unspecified stroke. Hazard ratios were estimated using Cox models pooled across random effect meta-analyses.120 diagnoses identified mean follow-up 2.1-5.5 years. After adjustment for age smoking hazard ratio 1.17 (95% confidence interval 1.05 1.30; 1035 events participants NASH, 67 823 controls). In group more complete data on factors (86 098 4 664 988 controls), systolic blood pressure, type 2 diabetes, total cholesterol level, statin use, hypertension 1.01 (0.91 1.12; 747 37 462 status 1.18 (1.11 1.24; 2187 134 001 factors, 1.04 (0.99 1.09; 1666 NAFLD, 83 882 controls) further hypertension.The current routine care 17.7 million patient appears not be associated established cardiovascular factors. Cardiovascular assessment is important but should done way as general population.

Language: Английский

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Clinical characteristics, surveillance, treatment allocation, and outcomes of non-alcoholic fatty liver disease-related hepatocellular carcinoma: a systematic review and meta-analysis

The Lancet Oncology, Journal Year: 2022, Volume and Issue: 23(4), P. 521 - 530

Published: March 4, 2022

The clinical presentation and outcomes of non-alcoholic fatty liver disease (NAFLD)-related hepatocellular carcinoma are unclear when compared with due to other causes. We aimed establish the prevalence, features, surveillance rates, treatment allocation, NAFLD-related carcinoma.

Language: Английский

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Administrative Coding in Electronic Health Care Record‐Based Research of NAFLD: An Expert Panel Consensus Statement

Hepatology, Journal Year: 2021, Volume and Issue: 74(1), P. 474 - 482

Published: Jan. 24, 2021

Electronic health record (EHR)-based research allows the capture of large amounts data, which is necessary in NAFLD, where risk clinical liver outcomes generally low. The lack consensus on International Classification Diseases (ICD) codes should be used as exposures and limits comparability generalizability results across studies. We aimed to establish among a panel experts ICD that could become reference standard provide guidance around common methodological issues.Researchers with an interest EHR-based NAFLD were invited collectively define administrative are most appropriate for documenting outcomes. modified Delphi approach reach several commonly encountered challenges field. After two rounds revision, high level agreement (>67%) was reached all items considered. Full achieved comprehensive list considered inclusion exclusion criteria defining research. also suggestions how issues identify areas future research.This expert statement can help harmonize improve

Language: Английский

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Redefining fatty liver disease: an international patient perspective

˜The œLancet. Gastroenterology & hepatology, Journal Year: 2020, Volume and Issue: 6(1), P. 73 - 79

Published: Oct. 5, 2020

Language: Английский

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Nonalcoholic Fatty Liver Disease and Recent Guideline Updates

Clinical Liver Disease, Journal Year: 2021, Volume and Issue: 17(1), P. 23 - 28

Published: Jan. 1, 2021

Watch a video presentation of this article Nonalcoholic fatty liver disease (NAFLD) is the most common chronic in United States and other industrialized nations. Its increase prevalence severity correlates with rise obesity metabolic syndrome, NAFLD now represents leading indication for transplantation States.1 The rising clinical economic burden has highlighted need streamlined approach to prevention, diagnosis, treatment disease. In review, we will summarize updated guideline guidance recommendations management adult NAFLD; highlight key difference between US, Asian, European recommendations; provide updates. 2012, American Association Study Liver Diseases (AASLD), College Gastroenterology, Gastroenterological published joint practice on NAFLD.2 diagnosis currently requires: (1) evidence hepatic steatosis (HS) by imaging or histology, (2) no significant alcohol consumption, (3) competing causes HS, (4) coexisting Research efforts have led progress our understanding An guidance, based expert consensus rather than systematic review literature, was AASLD 2018 help clinicians navigate recent into practice.3 should be used conjunction graded from previously guidelines. One notable change stronger emphasis assessment risk factors patients incidental findings HS normal chemistries but lacking liver-related symptoms. Growing supports that increased cardiovascular morbidity mortality.4 Moreover, advanced fibrosis associated increasing number comorbidities.5 Thus, early identification individual components syndrome are critical preventing both mortality. importance identifying staging degree underscored because it thought main driver overall mortality.6 original guideline, score only recommended tool assess noninvasively modalities were not yet readily available States. Fibrosis-4 (FIB-4), ultrasound-based elastography, magnetic resonance elastography been added arsenal clinically useful tools staging. Accessibility vary across institutions, provided optimal sequence diagnostic testing. More recently, international experts proposed changing name (dysfunction)-associated (MAFLD).7 paradigm shift MAFLD would reflect underlying pathogenesis, eliminate "negative" nomenclature, allow coexistence diseases, including alcoholic concern use an inclusive definition specifically address population nonalcoholic steatohepatitis (NASH) who at highest complications. Future research guidelines likely ongoing conversation within field currently. today's increasingly globalized world, awareness differences important high-quality care all backgrounds. (EASL), effort Diabetes Obesity, 2016.8 Asia-Pacific Working Party its 2017.9, 10 Both Asian grading recommendation assessment, development, evaluation (GRADE) rate quality strength each recommendation. Although many similarities exist guidelines, there several areas divergence outlined later (Table 1). All society characterize presence absence consumption. However, as amount considered "significant." conservative threshold mirrors exclusion criteria defined National Institutes Health Steatohepatitis Network database protocol. It keep mind thresholds oversimplified duration exposure, drinking pattern, susceptibility play role alcohol-induced injury. societies recommend against screening general population. recommends even high-risk populations lack effective drug treatment, cost-effectiveness analysis, unclear long-term benefits screening. A "high index suspicion" advised type 2 diabetes. acknowledges validated cost-utility studies cognizant regional variations health resources screened prognostic implications progressive state may at-risk groups, such diabetes obesity. Lean prevalent Asia, where almost quarter obese.11 insulin resistance (IR) altered body fat distribution mass per se better indicators patients. without diabetes, homeostatic model IR (HOMA-IR) provides acceptable estimate IR. Ultrasound remains first-line wide availability low cost. less reliable when <20%12 raises concerns underestimating NAFLD. Magnetic imaging–derived proton density fraction highly sensitive widely outside settings. Controlled attenuation parameter FibroScan system more ultrasound. point-of-care nature makes appealing monitor progression response, needed validity. histology gold standard differentiating simple assessing Due invasive costs, agree biopsy select individuals. suspicion confirm lead changes. differ they if and/or cannot excluded using noninvasive testing inconclusive. stratify high fibrosis, preferred algorithm suggestions guide referral hepatology. addition, follow-up strategy caveat determined. NASH indicates aggressive closer follow-up. There differentiate bland steatohepatitis. increases steatohepatitis, US suggest performing these least one component impractical. Furthermore, Food Drug Administration (FDA)–approved pharmacological therapy NASH, remain hesitant proceed biopsy. Once diagnosed, therapies include vitamin E mellitus (DM) pioglitazone, thiazolidinedione liraglutide, glucagon-like peptide-1 receptor agonist, shown benefit DM. Pharmacological area investigation. Hepatocellular carcinoma (HCC) related growing concern, particularly can occur cirrhosis.13 age, male sex, certain gene polymorphisms HCC. mortality surveillance HCC noncirrhotic determined time any Early recognition intervention improving outcomes reducing Despite this, widespread primary setting underdiagnosed real-world settings.14, 15 drugs targeting obtain FDA approval, surge interest stakeholders: patients, providers, payors, policymakers. fast-moving field, current soon outdated. updates outline practical hepatology targeted (Fig. pressing establish steatosis, cost-effective minimally manner.

Language: Английский

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Defining comprehensive models of care for NAFLD

Nature Reviews Gastroenterology & Hepatology, Journal Year: 2021, Volume and Issue: 18(10), P. 717 - 729

Published: June 25, 2021

Language: Английский

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Hepatocellular carcinoma surveillance — utilization, barriers and the impact of changing aetiology

Nature Reviews Gastroenterology & Hepatology, Journal Year: 2023, Volume and Issue: 20(12), P. 797 - 809

Published: Aug. 3, 2023

Language: Английский

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Associations of muscle mass and grip strength with severe NAFLD: A prospective study of 333,295 UK Biobank participants

Journal of Hepatology, Journal Year: 2022, Volume and Issue: 76(5), P. 1021 - 1029

Published: Jan. 24, 2022

Language: Английский

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Liver disease is a significant risk factor for cardiovascular outcomes – A UK Biobank study

Journal of Hepatology, Journal Year: 2023, Volume and Issue: 79(5), P. 1085 - 1095

Published: June 20, 2023

•Liver disease on cT1 MRI is associated with a high risk of CVD events, CVD-related hospitalization, and all-cause mortality.•The association between liver independent function tests, fibrosis metabolic risk.•Risk events increased even in the early stages chronic disease. Background & AimsChronic (CLD) cardiovascular (CVD) risk. We investigated whether signs (measured by iron-corrected T1-mapping [cT1]) were an major events.MethodsLiver activity (cT1) fat (proton density fraction [PDFF]) measured using LiverMultiScan® January 2016 February 2020 UK Biobank imaging sub-study. Using multivariable Cox regression, we explored associations (MRI) primary (coronary artery disease, atrial fibrillation [AF], embolism/vascular heart failure [HF] stroke), hospitalisation mortality. Liver blood biomarkers, general metabolism demographics also included. Subgroup analysis was conducted those without syndrome (defined as at least three of: large waist, triglycerides, low high-density lipoprotein cholesterol, systolic pressure, or elevated haemoglobin A1c).ResultsA total 33,616 participants (mean age 65 years, mean BMI 26 kg/m2, A1c 35 mmol/mol) had complete data linked clinical outcomes (median time to event onset: 1.4 years [range: 0.002-5.1]; follow-up: 2.5 1.1-5.2]). (cT1), but not (PDFF), higher any (hazard ratio 1.14; 95% CI 1.03–1.26; p = 0.008), AF (1.30; 1.12–1.51; <0.001); HF 1.09–1.56; 0.004); (1.27; 1.18-1.37; <0.001) mortality (1.19; 1.02–1.38; 0.026). FIB-4 index (1.06; 1.01–1.10; 0.007). Risk independently individuals (1.26; 1.13-1.4; <0.001).ConclusionLiver activity, cT1, incident mortality, pre-existing syndrome, fat.Impact implicationsChronic twofold greater incidence Our work shows that T1 mapping (14%), (27%) (19%). These findings highlight prognostic relevance comprehensive evaluation health populations and/or CLD, absence manifestations when there opportunity modify/address factors prevent progression. As such, they are relevant patients, carers, clinicians, policymakers. Chronic events. A1c). A <0.001). fat.

Language: Английский

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Association of GLP-1 Receptor Agonists and Hepatocellular Carcinoma Incidence and Hepatic Decompensation in Patients With Type 2 Diabetes

Gastroenterology, Journal Year: 2024, Volume and Issue: 167(4), P. 689 - 703

Published: April 29, 2024

Hepatocellular carcinoma (HCC) is a leading cause of cancer death. HCC preventable with about 70% attributable to modifiable risk factors. Glucagon-like peptide-1 receptor agonists (GLP-1RAs), Food and Drug Administration-approved medications for treating type 2 diabetes mellitus (T2DM), have pleiotropic effects on counteracting factors HCC. Here we evaluate the association GLP-1RAs incident in real-world population.

Language: Английский

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