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Aponte-Meléndez Y, Eckhardt B, Fong C, Padilla A, Trinidad-Martínez W, Maldonado-Rodríguez E, Agront N, Mateu-Gelabert P. Prevalence and associated risk factors of hepatitis C antibody and RNA among people who inject drugs in Puerto Rico. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 160:209308. [PMID: 38301921 PMCID: PMC11060894 DOI: 10.1016/j.josat.2024.209308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 12/08/2023] [Accepted: 01/24/2024] [Indexed: 02/03/2024]
Abstract
INTRODUCTION As a public health crisis, hepatitis C viral infection (HCV) is highly prevalent among people who inject drugs (PWID). We aimed to assess factors associated with HCV antibody (Ab) and HCV ribonucleic acid (RNA) positivity among PWID in Puerto Rico. METHODS The study recruited a total of 150 persons in rural and peri-urban community settings through the respondent-driven sampling method and administered a structured questionnaire. We conducted HIV and HCV testing using dried blood spots (DBS). We examined correlates of HCV infection with sociodemographics, drug use patterns, and injection practices using regression in bivariate and multivariable analysis. RESULTS Of the 150 participants, 89 % were male; 11 % were female; 72 % identified as mixed race; and the median duration of drug injection was 17.8 years. The mean age was 43.1 years, with 64 % of the population being from 23 to 45 years old. Among study participants (n = 150), the prevalence of HCV Ab was 73 %, and HCV RNA was 53 %. Factors significantly associated with HCV Ab and RNA included older age, increasing years of injection, incarceration, injecting other people, and identifying as Black. The belief that syringe air blowing reduces HCV transmission was also independently associated with HCV Ab positivity. CONCLUSIONS Our findings regarding risk factors associated with HCV infection show the need to enhance prevention and control strategies for reducing transmission among PWID. Direct-acting antiviral treatment, sustained access to harm reduction, and culturally tailored services will be required to substantially reduce rates of HCV. Community-based treatment models and treatment in correctional settings are needed.
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Affiliation(s)
- Yesenia Aponte-Meléndez
- CUNY Graduate School of Public Health and Health Policy, Institute for Implementation Science in Population Health (ISPH), 55 West 125(th) street, New York, NY 10027, USA; NYU Rory Meyers College of Nursing, 433 1(st) Ave., New York, NY, 10010, USA.
| | - Benjamin Eckhardt
- New York University School of Medicine, 550 First Avenue, New York, NY 10016, USA.
| | - Chunki Fong
- CUNY Graduate School of Public Health and Health Policy, Institute for Implementation Science in Population Health (ISPH), 55 West 125(th) street, New York, NY 10027, USA.
| | - Adriana Padilla
- CUNY Graduate School of Public Health and Health Policy, Institute for Implementation Science in Population Health (ISPH), 55 West 125(th) street, New York, NY 10027, USA.
| | - Wanda Trinidad-Martínez
- CUNY Graduate School of Public Health and Health Policy, Institute for Implementation Science in Population Health (ISPH), 55 West 125(th) street, New York, NY 10027, USA.
| | - Eric Maldonado-Rodríguez
- CUNY Graduate School of Public Health and Health Policy, Institute for Implementation Science in Population Health (ISPH), 55 West 125(th) street, New York, NY 10027, USA.
| | - Nancy Agront
- AbbVie Corp., Paseo Caribe Building Suite 22415 Ave Munoz Rivera San Juan, 00901, Puerto Rico.
| | - Pedro Mateu-Gelabert
- CUNY Graduate School of Public Health and Health Policy, Institute for Implementation Science in Population Health (ISPH), 55 West 125(th) street, New York, NY 10027, USA.
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Thomas J, Snih SA. Original Article: Liver disease, heart failure, and 13-year mortality among Mexican American older adults: Nativity differences. Ann Epidemiol 2023:S1047-2797(23)00229-6. [PMID: 38141743 DOI: 10.1016/j.annepidem.2023.12.004] [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: 06/08/2023] [Revised: 12/13/2023] [Accepted: 12/19/2023] [Indexed: 12/25/2023]
Abstract
PURPOSE To examine nativity differences of co-occurring liver disease (LD) and heart failure (HF) on 13-year mortality among Mexican American older adults. METHODS Prospective cohort study of 1,601 Mexican Americans aged ≥75 years from the Hispanic Established Population for the Epidemiologic Study of the Elderly (2004/05-2016). Participants were grouped into four groups: no LD and no HF (n=1,138), LD only (n=53), HF only (n=382), and both LD and HF (n=28). We used Cox proportional hazards regression model to estimate the hazard ratio (HR) and 95% confidence interval (CI) of death over time. RESULTS The HR of death, as a function of HF only, was 1.32 (95% CI=1.07-1.62) among US-born and 1.36 (95% CI=1.04-1.78) among foreign-born participants, vs. those with no LD and no HF. Among foreign-born participants, the HR of death as a function of LD and HF was 3.39 (95% CI=1.65-6.93) vs. those without either. LD alone was not associated with mortality in either group. Among US-born, co-occurring LD and HF was not associated with mortality. CONCLUSIONS Foreign-born participants with both LD and HF were at higher risk of mortality over 13 years of follow up.
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Affiliation(s)
- Janice Thomas
- John Sealy School of Medicine, The University of Texas Medical Branch, 301 University Blvd., Galveston, TX, 77555, USA; Department of Population Health and Health Disparities/School of Public and Population Health. The University of Texas Medical Branch, 301 University Blvd., Galveston, TX, 77555, USA.
| | - Soham Al Snih
- Department of Population Health and Health Disparities/School of Public and Population Health. The University of Texas Medical Branch, 301 University Blvd., Galveston, TX, 77555, USA; Division of Geriatrics & Palliative Medicine/Department of Internal Medicine. The University of Texas Medical Branch, 301 University Blvd., Galveston, TX, 77555, USA; Sealy Center on Aging. The University of Texas Medical Branch, 301 University Blvd., 77555, Galveston, TX, USA.
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Castellanos-Fernandez MI, Pal SC, Arrese M, Arab JP, George J, Méndez-Sánchez N. Nonalcoholic Fatty Liver Disease in Latin America and Australia. Clin Liver Dis 2023; 27:301-315. [PMID: 37024209 DOI: 10.1016/j.cld.2023.01.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
The epidemiologic and demographical features of nonalcoholic fatty liver disease (NAFLD) vary significantly across countries and continents. In this review, we analyze current data regarding prevalence of NAFLD in Latin America and Caribbean and Australia and review some peculiarities found in these regions. We stress the need of greater awareness of NAFLD and the development of cost-effective risk stratification strategies and clinical care pathways of the disease. Finally, we highlight the need of effective public health policies to control the main risk factors for NAFLD.
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Affiliation(s)
| | - Shreya C Pal
- Faculty of Medicine, National Autonomous University of Mexico, Av. Universidad 3000, Coyoacán, Mexico City, Mexico; Liver Research Unit, Medica Sur Clinic & Foundation, Mexico City, Mexico
| | - Marco Arrese
- Departamento de Gastroenterologia, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile; Centro de Envejecimiento y Regeneración (CARE), Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Juan Pablo Arab
- Departamento de Gastroenterologia, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile; Division of Gastroenterology, Department of Medicine, Schulich School of Medicine, Western University & London Health Sciences Centre, London, Ontario, Canada; Alimentiv, London, Ontario, Canada
| | - Jacob George
- Storr Liver Centre, The Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, New South Wales, Australia
| | - Nahum Méndez-Sánchez
- Faculty of Medicine, National Autonomous University of Mexico, Av. Universidad 3000, Coyoacán, Mexico City, Mexico; Liver Research Unit, Medica Sur Clinic & Foundation, Mexico City, Mexico.
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Villalona S, Ortiz V, Castillo WJ, Garcia Laumbach S. Cultural Relevancy of Culinary and Nutritional Medicine Interventions: A Scoping Review. Am J Lifestyle Med 2022; 16:663-671. [PMID: 36389044 PMCID: PMC9644144 DOI: 10.1177/15598276211006342] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 02/14/2021] [Accepted: 03/11/2021] [Indexed: 10/15/2023] Open
Abstract
Background. Taking into account the disproportionate impacts of disease burden from chronic conditions by racial and ethnic group, this scoping review sought to examine the extent to which nutritional interventions incorporated culturally relevant topics into their design and analyses. Methods. A literature search of 5 databases was conducted for any peer-reviewed studies on nutritional and culinary medicine interventions published between 2000 and 2019. Results. Studies were divided into 2 categories, medical education interventions (n = 12) and clinical/community interventions (n = 20). The majority of medical education interventions were not culturally tailored and focused on obesity/weight management within the Northeast and Southeast United States. In contrast, clinical/community interventions were primarily culturally tailored for Latinos/Hispanics and African American/Black populations residing in the Northeast and diagnosed with prediabetes/diabetes mellitus or hypertension/cardiovascular disease. Conclusions. This review identified an existent gap and need for inclusive studies that consider the culturally relevant topics into the design and implementation of nutritional intervention studies. Studies within medical education appeared to be the area where these changes can be most beneficial. There may be some value among clinic and communal-based studies in stratifying heterogeneous subgroups because of the missed cultural nuances missed when grouping larger racial cohorts.
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Affiliation(s)
| | - Vanessa Ortiz
- Rutgers Robert Wood Johnson Medical School,
Piscataway, New Jersey
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5
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Gelpí-Acosta C, Cano M, Hagan H. Racial and ethnic data justice: The urgency of surveillance data disaggregation. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 4:100082. [PMID: 36712292 PMCID: PMC9881686 DOI: 10.1016/j.dadr.2022.100082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Disease and overdose surveillance across industrialized countries, including the United States (US), have historically relied upon racial and ethnic classifications such as Non-Hispanic Black, White, Asian and Hispanic/Latinx to characterize the populations it describes. These categories underestimate significant HIV, hepatitis C (HCV) and drug overdose variance within these groups, by both place of birth and ethnicity. For socioeconomically disadvantaged people of color in the US, frontline workers (i.e., harm reduction outreach workers, case managers, etc.) are a medullar entry point to the HIV, HCV, and drug misuse care continuums. Racial/ethnic data aggregates fail to characterize vulnerable groups in ways that can increase these workers’ efficacy. HIV, HCV, and overdose data disaggregation is urgent to end HIV and to control HCV and drug overdoses more effectively, and to also move closer to an anti-racist epidemiology.
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Affiliation(s)
- Camila Gelpí-Acosta
- LaGuardia Community College, City University of New York, USA,Corresponding author.
| | - Manuel Cano
- School of Social Work, Arizona State University, USA
| | - Holly Hagan
- School of Global Public Health, Center for Drug Use and HIV/HCV Research, NYU, USA
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6
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Variation in US drug overdose mortality within and between Hispanic/Latine subgroups: A disaggregation of national data. SSM - MENTAL HEALTH 2022. [DOI: 10.1016/j.ssmmh.2022.100095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Ryu E, Xia HH, Guo GL, Zhang L. Multivariable-adjusted trends in mortality due to alcoholic liver disease among adults in the United States, from 1999-2017. Am J Transl Res 2022; 14:1092-1099. [PMID: 35273712 PMCID: PMC8902556 DOI: pmid/35273712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 01/17/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Mortality-trends from alcoholic liver disease (ALD) have recently increased and they differ by various factors in the U.S. However, these trends have only been analyzed using univariate models and in reality they may be influenced by various factors. We thus examined trends in age-standardized mortality from ALD among U.S. adults for 1999-2017, using multivariable piecewise log-linear models. METHODS We collected mortality-data from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research database, using the Underlying Cause of Death. RESULTS We identified 296,194 deaths from ALD and 346,386 deaths indirectly attributable to ALD during the period from 1999-2017. The multivariable-adjusted, age-standardized ALD mortality was stable during 1999-2006 (annual percentage change [APC]=-2.24, P=0.24), and increased during 2006-2017 (APC=3.18, P<0.006). Their trends did not differ by sex, race, age or urbanization. Subgroup analyses revealed upward multivariable-adjusted, age-standardized mortality-trends in alcoholic fatty liver (APC=4.64, P<0.001), alcoholic hepatitis (APC=4.38, P<0.001), and alcoholic cirrhosis (APC=5.33, P<0.001), but downward mortality-trends in alcoholic hepatic failure (APC=-1.63, P=0.006) and unspecified ALD (APC=-0.86, P=0.013). Strikingly, non-alcoholic cirrhosis also had an upward multivariable-adjusted, age-standardized mortality-trend (APC=0.69, P=0.046). By contrast, recent mortality-trends were stable for all cause of deaths (APC=-0.39, P=0.379) and downward for malignant neoplasms excluding liver cancer (APC=-2.82, P<0.001), infections (APC=-2.60, P<0.001), cardiovascular disease (APC=-0.69, P=0.044) and respiratory disease (APC=-0.56, P=0.002). The adjusted mortality with ALD as a contributing cause of death also had an upward trend during 2000-2017 (APC=5.47, P<0.001). Strikingly, common comorbidities of ALD, including hepatocellular carcinoma, cerebrovascular and ischemic heart cardiovascular diseases and sepsis, had upward trends during the past 14 to 16 years. CONCLUSIONS ALD had an upward multivariable-adjusted, age-standardized mortality-trend among U.S. adults, without significant differences by sex, race, age or urbanization. Three ALD subtypes (alcoholic fatty liver, alcoholic hepatitis and alcoholic cirrhosis) and non-alcoholic cirrhosis had upward morality-trends, while other ALD subtypes and other causes of death did not.
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Affiliation(s)
- Emily Ryu
- Department of Chemistry, Princeton UniversityPrinceton, NJ 08544, USA
| | - Harry H Xia
- Department of Gastroenterology, First Affiliated Hospital, Guangdong Pharmaceutical UniversityGuangzhou 510000, Guangdong, China
| | - Grace L Guo
- Department of Pharmacology and Toxicology, Ernest Mario School of Pharmacy, Rutgers UniversityPiscataway, NJ 08854, USA
- Environmental and Occupational Health Sciences Institute, Rutgers, State University of New JerseyPiscataway, NJ 08854, USA
| | - Lanjing Zhang
- Department of Pathology, Princeton Medical CenterPlainsboro, NJ 08563, USA
- Department of Biological Sciences, Rutgers University NewarkNJ 07102, USA
- Department of Chemical Biology, Ernest Mario School of Pharmacy, Rutgers UniversityPiscataway, NJ 08854, USA
- Rutgers Cancer Institute of New JerseyNew Brunswick, NJ 08901, USA
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Bonacini M, Kassamali F, Kari S, Lopez Barrera N, Kohla M. Racial differences in prevalence and severity of non-alcoholic fatty liver disease. World J Hepatol 2021; 13:763-773. [PMID: 34367497 PMCID: PMC8326166 DOI: 10.4254/wjh.v13.i7.763] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 04/08/2021] [Accepted: 07/07/2021] [Indexed: 02/06/2023] Open
Abstract
The aim of this review is to assess the evidence regarding racial differences in the prevalence and severity of nonalcoholic fatty liver disease (NAFLD). We reviewed the published literature that reported prevalence, severity, and genetic associations of NAFLD in different ethnic groups. The metabolic syndrome (MetS) has been associated with NAFLD, but each component of the MetS is present in various races in different percentages and their effect on NAFLD appears to be dissimilar. An elevated triglyceride (TG) level seems to have the strongest association with NAFLD. The latter is more prevalent in Hispanic patients; Blacks have lower TG levels and a lower NAFLD prevalence, compared to Caucasians or Hispanics. The severity of liver fibrosis is lower in some, but not all biopsy-based studies of Black patients. No study has evaluated the severity of liver disease controlling for the individual components of MetS, especially TG. Important racial differences in the prevalence of selected genetic polymorphisms, particularly PNPLA-3 and MBOAT7 have been documented, together with their effects on the prevalence of liver steatosis and fibrosis. Data on overall and liver mortality have found no significant differences according to race/ethnicity, with the possible exception of one paper reporting lower cirrhosis mortality in Black patients. We conclude that NAFLD is more prevalent in Hispanics and less in Blacks. This is supported by differences in key genetic polymorphisms associated with hepatic fat storage. However, there is presently insufficient evidence to firmly conclude that race, per se, plays a role in the development of liver fibrosis and its complications. Further studies, appropriately controlled for diet, exercise, and individual MetS parameters are needed.
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Affiliation(s)
- Maurizio Bonacini
- Department of Gastroenterology and Hepatology, California Pacific Medical Center, California Pacific Medical Center, San Francisco, CA 94115, United States
| | - Farah Kassamali
- Department of Gastroenterology and Hepatology, California Pacific Medical Center, San Francisco, CA 94115, United States
| | - Swathi Kari
- Department of Internal Medicine, St. Mary's medical Center, San Francisco, CA 94117, United States
| | | | - Mohamed Kohla
- Department of Hepatology, National Liver Institute, Menoufiya University, Shibin Al Kom 32511, Menoufiya, Egypt
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Texas Has the Highest Hepatocellular Carcinoma Incidence Rates in the USA. Dig Dis Sci 2021; 66:912-916. [PMID: 32303951 DOI: 10.1007/s10620-020-06231-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 03/23/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Texas is the second largest state by area and population in the USA and is reported to have high incidence and mortality rates for hepatocellular carcinoma (HCC). The reasons for the increasingly high burden of HCC in Texas are not clear. AIMS We explored trends and demographic and regional variations in HCC incidence to better understand reasons for the high burden in Texas. METHODS We analyzed Texas Cancer Registry incidence data from 2001 to 2015 and compared results to the U.S. National Program of Cancer Registries and SEER for the same period. Rates were stratified by sex, race/ethnicity, and age at diagnosis. Rates were also compared between the US/Mexico border region of Texas and the rest of Texas. RESULTS Texas had the highest HCC age-adjusted incidence rate of all states, 13.2/100,000, which was 45% higher than the national average. In Texas and nationally, rates increased by 4% per year between 2001 and 2015. Rates in Texas were 26-37% greater than national rates for Hispanics, African-Americans, and non-Hispanic whites. Among Hispanics in states with the largest percentage of Hispanics, Texas-based Hispanics had the highest HCC incidence rate in 2015 (21.2/100,000) compared with Hispanics in New Mexico, California, Arizona, Nevada, and Florida. Incidence rates were highest in South Texas and US/Mexico border regions. CONCLUSIONS Increasing rates in the large Hispanic population may explain why Texas now has the highest HCC incidence rate in the USA.
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10
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Chu H, Jiang L, Gao B, Gautam N, Alamoudi JA, Lang S, Wang Y, Duan Y, Alnouti Y, Cable EE, Schnabl B. The selective PPAR-delta agonist seladelpar reduces ethanol-induced liver disease by restoring gut barrier function and bile acid homeostasis in mice. Transl Res 2021; 227:1-14. [PMID: 32553670 PMCID: PMC7719076 DOI: 10.1016/j.trsl.2020.06.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 06/01/2020] [Accepted: 06/08/2020] [Indexed: 12/13/2022]
Abstract
Alcohol-associated liver disease is accompanied by dysregulation of bile acid metabolism and gut barrier dysfunction. Peroxisome proliferator-activated receptor-delta (PPARδ) agonists are key metabolic regulators and have anti-inflammatory properties. Here, we evaluated the effect of the selective PPAR-delta agonist seladelpar (MBX-8025) on gut barrier function and bile acid metabolism in a mouse model of ethanol-induced liver disease. Wild type C57BL/6 mice were fed LieberDeCarli diet containing 0%-36% ethanol (caloric) for 8 weeks followed by a single binge of ethanol (5 g/kg). Pair fed mice received an isocaloric liquid diet as control. MBX-8025 (10 mg/kg/d) or vehicle were added to the liquid diet during the entire feeding period (prevention), or during the last 4 weeks of Lieber DeCarli diet feeding (intervention). In both prevention and intervention trials, MBX-8025 protected mice from ethanol-induced liver disease, characterized by lower serum alanine aminotransferase (ALT) levels, hepatic triglycerides, and inflammation. Chronic ethanol intake disrupted bile acid metabolism by increasing the total bile acid pool and serum bile acids. MBX-8025 reduced serum total and secondary bile acids, and the total bile acid pool as compared with vehicle treatment in both prevention and intervention trials. MBX-8025 restored ethanol-induced gut dysbiosis and gut barrier dysfunction. Data from this study demonstrates that seladelpar prevents and treats ethanol-induced liver damage in mice by direct PPARδ agonism in both the liver and the intestine.
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Affiliation(s)
- Huikuan Chu
- Department of Medicine, University of California San Diego, La Jolla, California; Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lu Jiang
- Department of Medicine, University of California San Diego, La Jolla, California; Department of Medicine, VA San Diego Healthcare System, San Diego, California
| | - Bei Gao
- Department of Medicine, University of California San Diego, La Jolla, California
| | - Nagsen Gautam
- Department of Pharmaceutical Sciences, University of Nebraska Medical Center, Omaha, Nebraska
| | - Jawaher A Alamoudi
- Department of Pharmaceutical Sciences, University of Nebraska Medical Center, Omaha, Nebraska
| | - Sonja Lang
- Department of Medicine, University of California San Diego, La Jolla, California
| | - Yanhan Wang
- Department of Medicine, University of California San Diego, La Jolla, California
| | - Yi Duan
- Department of Medicine, University of California San Diego, La Jolla, California
| | - Yazen Alnouti
- Department of Pharmaceutical Sciences, University of Nebraska Medical Center, Omaha, Nebraska
| | | | - Bernd Schnabl
- Department of Medicine, University of California San Diego, La Jolla, California.
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Khalid YS, Reja D, Dasu NR, Suga HP, Dasu KN, Joo LM. In-Hospital Outcomes of Patients with Acute Decompensated Heart Failure and Cirrhosis: An Analysis of the National Inpatient Sample. Cardiol Ther 2020; 9:433-445. [PMID: 32514825 PMCID: PMC7584689 DOI: 10.1007/s40119-020-00183-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Heart failure increases morbidity and mortality in patients admitted for cirrhosis. Our objective was to determine if patients with acute decompensated heart failure (ADHF) and cirrhosis would have increased mortality, hospital length of stay (LOS), and total hospital charges compared to patients with only ADHF. There is also a paucity of data regarding the influence of gender, race, ethnicity, insurance, and cirrhosis-related complications on mortality, hospital length of stay, and total hospitalization charges. In this study, we aim to identify risk factors in a national population cohort from 2016. METHODS All patients above 18 years old with cirrhosis and ADHF admitted in 2016 were identified from the Nationwide Inpatient Sample (NIS). Multivariate regression analysis was used to estimate the odds ratio of in-hospital mortality, average length of stay (LOS), and total hospital charges after adjusting for the following factors: age, gender, race, Charlson and Elixhauser scores, primary insurance payer status, hospital type, hospital bed size, hospital region, and hospital teaching status. Statistical analysis was performed by using the survey procedures function in the statistical analysis system (SAS) software. Statistical significance was defined by the two-sided t-test with a p value < 0.05. RESULTS The overall sample contained 363,050 patients. A total of 355,455 patients were admitted with ADHF and 2% of these patients had concomitant cirrhosis (n = 7595) in 2016. The total mortality rate was 3.4%, hospital LOS was 6.6 days (with a median of 6.5 days), and the mean total hospital charge was $63,120.20. Patients with both ADHF and cirrhosis compared to patients without ADHF had increased mortality, hospital LOS, and cirrhosis-related complications. CONCLUSIONS As the incidence and prevalence of ADHF and cirrhosis increases worldwide, we urge the medical community to increase surveillance of patients with both diseases and perform rigorous cardiovascular risk assessments as well to improve patient outcomes.
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Affiliation(s)
- Yaser S Khalid
- Division of Internal Medicine, Rowan University School of Medicine at Jefferson Health System, Stratford, NJ, USA.
| | - Debashis Reja
- Division of Internal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Neethi R Dasu
- Division of Internal Medicine, Rowan University School of Medicine at Jefferson Health System, Stratford, NJ, USA
| | - Herman P Suga
- Division of Internal Medicine, Rowan University School of Medicine at Jefferson Health System, Stratford, NJ, USA
| | - Kirti N Dasu
- Division of Biology, Syracuse University, Syracuse, NY, USA
| | - Lucy M Joo
- Division of Gastroenterology, Jefferson Health New Jersey, New Jersey, USA
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Avilés-Santa ML, Hsu L, Lam TK, Arteaga SS, Artiles L, Coady S, Cooper LS, Curry J, Desvigne-Nickens P, Nicastro HL, Rosario A. Funding of Hispanic/Latino Health-Related Research by the National Institutes of Health: An Analysis of the Portfolio of Research Program Grants on Six Health Topic Areas. Front Public Health 2020; 8:330. [PMID: 33014952 PMCID: PMC7493677 DOI: 10.3389/fpubh.2020.00330] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 06/15/2020] [Indexed: 12/15/2022] Open
Abstract
Hispanics/Latinos are expected to constitute 25% of the U.S. population by 2060. Differences in the prevalence of health risk factors, chronic diseases, and access to and utilization of health-care services between Hispanics/Latinos and other populations in the U.S. have been documented. This study aimed to describe and analyze the landscape of Research Program Grants (RPGs) funded by the National Institutes of Health (NIH) between 2008 and 2015 involving Hispanic/Latino health research in six health condition areas-asthma, cancer, dementia, diabetes, liver/gallbladder disease, and obesity-and to identify opportunities for continued research in these areas. Using an NIH internal search engine, we identified new and renewal Hispanic/Latino health RPGs searching for specific Hispanic/Latino identifiers in the Title, Abstract, and Specific Aims. We used descriptive statistics to examine the distribution of funded RPGs by NIH disease-based classification codes for the six health condition areas of interest, and other selected characteristics. The most prominent clusters of research subtopics were identified within each health condition area, and performance sites were mapped at the city level. Within the selected time frame, 3,221 Hispanic/Latino health-related unique RPGs were funded (constituting 4.4% of all funded RPGs), and of those 625 RPGs were eligible for review and coding in the present study. Cancer and obesity were the most commonly studied health condition areas (72%), while studies on mechanisms of disease-biological and non-biological-(72.6%), behavioral research (42.1%) and epidemiological studies (38.1%) were the most common types of research. Most of the primary performance sites were in California, Texas, the northeastern U.S., and Illinois. The predominance of mechanistic, behavioral, and epidemiological studies in our analysis poses opportunities to evaluate knowledge gained and their clinical application, explore new research questions, or to update some methods or instruments. The findings of the present study suggest opportunities to expand research in understudied mechanisms of disease that could explain differences in prevalence of conditions like diabetes and cancer among different heritage groups. In addition, our findings suggest that the impact of interventions or policies designed to reduce health disparities, innovative multi-level interventions, implementation and dissemination studies, the role of health information technology on health outcomes, and the intersectionality of individual, sociocultural, geographic, and other factors on health outcomes, among others, are understudied approaches, which could potentially advance research in Hispanic/Latino health and contribute to the achievement of better health outcomes in this diverse population.
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Affiliation(s)
- M. Larissa Avilés-Santa
- Clinical and Health Services Research, National Institute on Minority Health and Health Disparities, Bethesda, MD, United States
| | - Laura Hsu
- Division of Extramural Research Activities, National Heart, Lung, and Blood Institute, Bethesda, MD, United States
| | - Tram Kim Lam
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, United States
| | - S. Sonia Arteaga
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD, United States
| | - Ligia Artiles
- Division of Scientific Programs, National Institutes on Minority Health and Health Disparities, Bethesda, MD, United States
| | - Sean Coady
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD, United States
| | - Lawton S. Cooper
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD, United States
| | - Jennifer Curry
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, Bethesda, MD, United States
| | - Patrice Desvigne-Nickens
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD, United States
| | - Holly L. Nicastro
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD, United States
| | - Adelaida Rosario
- Division of Scientific Programs, National Institutes on Minority Health and Health Disparities, Bethesda, MD, United States
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13
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Lee HF, Chan YH, Chang SH, Tu HT, Chen SW, Yeh YH, Wu LS, Kuo CF, Kuo CT, See LC. Effectiveness and Safety of Non-Vitamin K Antagonist Oral Anticoagulant and Warfarin in Cirrhotic Patients With Nonvalvular Atrial Fibrillation. J Am Heart Assoc 2020; 8:e011112. [PMID: 30834802 PMCID: PMC6474939 DOI: 10.1161/jaha.118.011112] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background Liver cirrhotic patients with nonvalvular atrial fibrillation have been excluded from randomized clinical studies regarding oral anticoagulants for stroke prevention. Whether non–vitamin K antagonist oral anticoagulants (NOACs) are superior to warfarin for these patients remains unclear. Methods and Results This nationwide retrospective cohort study, with data collected from the Taiwan National Health Insurance Research Database, enrolled 2428 liver cirrhotic patients with nonvalvular atrial fibrillation taking apixaban (n=171), dabigatran (n=535), rivaroxaban (n=732), or warfarin (n=990) from June 1, 2012, to December 31, 2016. We used propensity score–based stabilized weights to balance covariates across study groups. Patients were followed until the occurrence of an event or the end date of study. The NOAC group (n=1438) showed risk of ischemic stroke/systemic embolism and intracranial hemorrhage comparable to that of the warfarin group (n=990) after adjustment. The NOAC group showed significantly lower risk of gastrointestinal bleeding (hazard ratio: 0.51 [95% CI, 0.32–0.79]; P=0.0030) and all major bleeding (hazard ratio: 0.51 [95% CI, 0.32–0.74]; P=0.0003) compared with warfarin group. Overall, 90% (n=1290) of patients were taking a low‐dose NOAC (apixaban 2.5 mg twice daily, rivaroxaban 10–15 mg daily, or dabigatran 110 mg twice daily). The subgroup analysis indicated that both dabigatran and rivaroxaban showed lower risk of all major bleeding than warfarin. The advantage of lower gastrointestinal and all major bleeding with NOACs over warfarin is contributed by those subgroups with either nonalcoholic or nonadvanced liver cirrhosis. Conclusions NOACs have a risk of thromboembolism comparable to that of warfarin and a lower risk of major bleeding among liver cirrhotic Asian patients with nonvalvular atrial fibrillation. Consequently, thromboprophylaxis with low‐dose NOACs may be considered for such patients. See Editorial by Gallagher et al
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Affiliation(s)
- Hsin-Fu Lee
- 1 Cardiovascular Department Chang Gung Memorial Hospital Linkou, Taoyuan Taiwan.,6 College of Medicine Chang Gung University Taoyuan Taiwan.,7 Graduate Institute of Clinical Medical Sciences College of Medicine Chang Gung University Taoyuan Taiwan
| | - Yi-Hsin Chan
- 1 Cardiovascular Department Chang Gung Memorial Hospital Linkou, Taoyuan Taiwan.,2 Microscopy Core Laboratory Chang Gung Memorial Hospital Linkou, Taoyuan Taiwan.,6 College of Medicine Chang Gung University Taoyuan Taiwan
| | - Shang-Hung Chang
- 1 Cardiovascular Department Chang Gung Memorial Hospital Linkou, Taoyuan Taiwan.,3 Center for Big Data Analytics and Statistics Chang Gung Memorial Hospital Linkou, Taoyuan Taiwan.,6 College of Medicine Chang Gung University Taoyuan Taiwan
| | - Hui-Tzu Tu
- 3 Center for Big Data Analytics and Statistics Chang Gung Memorial Hospital Linkou, Taoyuan Taiwan.,8 Department of Public Health College of Medicine Chang Gung University Taoyuan Taiwan
| | - Shao-Wei Chen
- 1 Cardiovascular Department Chang Gung Memorial Hospital Linkou, Taoyuan Taiwan.,4 Division of Thoracic and Cardiovascular Surgery Department of Surgery Chang Gung Memorial Hospital Linkou, Taoyuan Taiwan.,6 College of Medicine Chang Gung University Taoyuan Taiwan
| | - Yung-Hsin Yeh
- 1 Cardiovascular Department Chang Gung Memorial Hospital Linkou, Taoyuan Taiwan.,6 College of Medicine Chang Gung University Taoyuan Taiwan
| | - Lung-Sheng Wu
- 1 Cardiovascular Department Chang Gung Memorial Hospital Linkou, Taoyuan Taiwan.,6 College of Medicine Chang Gung University Taoyuan Taiwan
| | - Chang-Fu Kuo
- 3 Center for Big Data Analytics and Statistics Chang Gung Memorial Hospital Linkou, Taoyuan Taiwan.,5 Division of Rheumatology, Allergy and Immunology Department of Internal Medicine Chang Gung Memorial Hospital Linkou, Taoyuan Taiwan.,6 College of Medicine Chang Gung University Taoyuan Taiwan
| | - Chi-Tai Kuo
- 1 Cardiovascular Department Chang Gung Memorial Hospital Linkou, Taoyuan Taiwan.,6 College of Medicine Chang Gung University Taoyuan Taiwan
| | - Lai-Chu See
- 3 Center for Big Data Analytics and Statistics Chang Gung Memorial Hospital Linkou, Taoyuan Taiwan.,5 Division of Rheumatology, Allergy and Immunology Department of Internal Medicine Chang Gung Memorial Hospital Linkou, Taoyuan Taiwan.,8 Department of Public Health College of Medicine Chang Gung University Taoyuan Taiwan.,9 Biostatistics Core Laboratory Molecular Medicine Research Center Chang Gung University Taoyuan Taiwan
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14
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Ryu E, Xia HH, Guo GL, Zhang L. Trends in mortality of alcoholic liver disease among adults in the United States, 1999-2017.. [DOI: 10.1101/2020.06.17.20133827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AbstractSome subtypes of alcoholic liver disease (ALD) recently had increasing prevalence or mortality. Prevalence of alcoholic fatty liver disease was increased. Mortality of alcoholic hepatitis and cirrhosis also had upward trends. However, trends in ALD- mortality and related factors are unclear. We therefore examined trends in age-standardized ALD-mortality among U.S. adults by factors using multivariable piecewise log-linear models. We collected mortality-data (age-standardized for the 2000 U.S. standard population) from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research database (CDC WONDER), using the Multiple Cause of Death Data to identify all ALD deaths in the United States for 1999-2017. We identified 296,194 deaths of ALD during 1999-2017. Trends in multivariable-adjusted, age-standardized mortality did not differ by sex, race, age or urbanization. The age-standardized mortality ratios of male/female, White/non-White and Metropolitan/Non-Metropolitan were 2.346, 1.657 and 0.851 in 2017, respectively. Strikingly, our multivariable model showed that subjects of 65+ years had the highest and the fastest growing mortality in the 3 age-groups. These findings highlight the continuation of health disparities in ALD, particularly in elderly subjects. Further works are warranted to validate and delineate the associated factors.
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15
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Genetic Factors and Continental Ancestry Account for Some Disparities in Nonalcoholic Fatty Liver Disease Among Hispanic Subgroups. Clin Gastroenterol Hepatol 2019; 17:2176-2178. [PMID: 31009797 DOI: 10.1016/j.cgh.2019.04.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 04/12/2019] [Accepted: 04/13/2019] [Indexed: 02/07/2023]
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16
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Paik JM, Henry L, De Avila L, Younossi E, Racila A, Younossi ZM. Mortality Related to Nonalcoholic Fatty Liver Disease Is Increasing in the United States. Hepatol Commun 2019; 3:1459-1471. [PMID: 31701070 PMCID: PMC6824058 DOI: 10.1002/hep4.1419] [Citation(s) in RCA: 132] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 07/21/2019] [Indexed: 12/14/2022] Open
Abstract
Population‐level nonalcoholic fatty liver disease (NAFLD) death rate data are sparse. We described death rates for adults with NAFLD in the United States using mortality data from the National Vital Statistics System multiple‐cause mortality data (2007‐2016). Decedents who had NAFLD were identified by International Classification of Diseases (ICD) codes K75.81, K76.0, K74.0, K74.6, and K76.9. Among NAFLD decedents, cause‐specific deaths (e.g., cardiovascular disease [CVD], cirrhosis, hepatocellular carcinoma [HCC], non‐liver cancer, diabetes mellitus [DM]) were identified by underlying cause of death ICD‐10 codes. Trends were evaluated by average annual percentage change (AAPC) in age‐standardized death rate (ASDR) per 100,000 persons. Among the 25,129,960 decedents aged ≥20 years, 353,234 (1.4%) decedents had NAFLD (212,322 men; 260,765 non‐Hispanic whites, 32,868 non‐Hispanic blacks, 46,530 Hispanics, 5,025 non‐Hispanic American Indian or Alaska Natives [AIANs], 7,023 non‐Hispanic Asian or Pacific Islanders [APIs]), with a mean age at death of 64.47 ± 13.17 years. During the study period, the ASDR for NAFLD increased by 15% (12.94 to 14.90; AAPC, 1.98%; P < 0.001]), while women (AAPC, 2.99% vs. 1.16% men; P = 0.003), non‐Hispanic whites (AAPC, 2.48%), non‐Hispanic AIANs (AAPC, 2.31%), and Hispanics (AAPC, 0.74%) experienced the highest annual increases. Stable trends were noted for non‐Hispanic blacks and non‐Hispanic APIs. Among subgroups, Mexican (AAPC, 1.75%) and Asian Indians (AAPC, 6.94%) experienced annual increases. The top six underlying causes of death (155,894 cirrhosis, 38,444 CVD, 19,466 non‐liver cancer, 10,867 HCC, 8,113 DM, and 5,683 lung disease) accounted for 67.5% of NAFLD‐related deaths. For cause‐specific deaths, ASDR increased for HCC (AAPC, 3.82%), DM (AAPC, 2.23%), non‐liver cancer (AAPC, 2.14%), CVD (AAPC, 1.59%), and cirrhosis (AAPC, 0.96%). Conclusion: NAFLD‐related deaths in U.S. adults are increasing. Cirrhosis is the top cause‐specific death, followed by CVD. Women, non‐Hispanic whites, and non‐Hispanic AIANs (subgroups Mexicans and Asian Indians) experienced the highest increases in deaths. Policies addressing the societal burden of NAFLD are needed.
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Affiliation(s)
- James M Paik
- Betty and Guy Beatty Center for Integrated Research Inova Health System Falls Church VA
| | - Linda Henry
- Center for Outcomes Research in Liver Diseases Washington DC
| | - Leyla De Avila
- Betty and Guy Beatty Center for Integrated Research Inova Health System Falls Church VA
| | - Elena Younossi
- Betty and Guy Beatty Center for Integrated Research Inova Health System Falls Church VA
| | - Andrei Racila
- Betty and Guy Beatty Center for Integrated Research Inova Health System Falls Church VA
| | - Zobair M Younossi
- Betty and Guy Beatty Center for Integrated Research Inova Health System Falls Church VA.,Center for Liver Disease, Department of Medicine Inova Fairfax Medical Campus Falls Church VA
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17
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Yoo ER, Ahmed A, Kim D. Economic burden and healthcare utilization in nonalcoholic fatty liver disease. Hepatobiliary Surg Nutr 2019; 8:181-183. [PMID: 31098375 DOI: 10.21037/hbsn.2018.12.11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Eric R Yoo
- Department of Internal Medicine, Santa Clara Valley Medical Center, San Jose, CA, USA
| | - Aijaz Ahmed
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, USA
| | - Donghee Kim
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, USA
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