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Weinstein G, Schonmann Y, Yeshua H, Zelber‐Sagi S. The association between liver fibrosis score and incident dementia: A nationwide retrospective cohort study. Alzheimers Dement 2024; 20:5385-5397. [PMID: 38946688 PMCID: PMC11350139 DOI: 10.1002/alz.14033] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 04/30/2024] [Accepted: 05/05/2024] [Indexed: 07/02/2024]
Abstract
BACKGROUND We assessed the relationship of liver fibrosis score with incident dementia in a large, national sample. METHODS For this retrospective cohort study, data of dementia-free individuals aged 40-69 years were derived from electronic records of the largest healthcare provider in Israel. The association between liver fibrosis score (FIB-4), assessed from routine laboratory measurements, and incident dementia was explored through multivariate cox regression models. RESULTS Of the total sample (N = 826,578, mean age 55 ± 8 years at baseline), 636,967 (77%) had no fibrosis, 180,114 (21.8%) had inconclusive fibrosis status and 9497 (1.2%) had high risk for advanced fibrosis. Over a median follow-up of 17 years, 41,089 dementia cases were recorded. Inconclusive liver fibrosis and advanced fibrosis were associated with increased dementia risk (HR = 1.09, 95%CI: 1.07-1.11 and HR = 1.18, 95%CI: 1.10-1.27, respectively). This association remained robust through seven sensitivity analyses. CONCLUSIONS Liver fibrosis assessed through a serum-based algorithm may serve as a risk factor for dementia in the general population. HIGHLIGHTS Liver fibrosis may predict dementia diagnosis in the general population. Inconclusive liver fibrosis was associated with 9% increased dementia risk. Advanced liver fibrosis was associated with 18% increased dementia risk. Findings remained robust in sensitivity analyses and after adjustments.
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Affiliation(s)
| | - Yochai Schonmann
- Siaal Research Center for Family Medicine and Primary CareFaculty of Health SciencesBen‐Gurion University of the NegevBeer‐ShevaIsrael
- Department of Quality Measurements and ResearchClalit Health ServicesTel‐AvivIsrael
- Department of Family MedicineTel‐Aviv District, Clalit Health ServicesTel‐AvivIsrael
| | - Hanny Yeshua
- Department of Family MedicineTel‐Aviv District, Clalit Health ServicesTel‐AvivIsrael
- Faculty of MedicineTel‐Aviv UniversityTel‐AvivIsrael
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Bech KT, Lindvig KP, Thiele M, Castera L. Algorithms for Early Detection of Silent Liver Fibrosis in the Primary Care Setting. Semin Liver Dis 2024; 44:23-34. [PMID: 38262447 DOI: 10.1055/s-0043-1778127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
More than one-third of the adult world population has steatotic liver disease (SLD), with a few percent of individuals developing cirrhosis after decades of silent liver fibrosis accumulation. Lack of systematic early detection causes most patients to be diagnosed late, after decompensation, when treatment has limited effect and survival is poor. Unfortunately, no isolated screening test in primary care can sufficiently predict advanced fibrosis from SLD. Recent efforts, therefore, combine several parameters into screening algorithms, to increase diagnostic accuracy. Besides patient selection, for example, by specific characteristics, algorithms include nonpatented or patented blood tests and liver stiffness measurements using elastography-based techniques. Algorithms can be composed as a set of sequential tests, as recommended by most guidelines on primary care pathways. Future use of algorithms that are easy to interpret, cheap, and semiautomatic will improve the management of patients with SLD, to the benefit of global health care systems.
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Affiliation(s)
- Katrine Tholstrup Bech
- Department of Gastroenterology and Hepatology, Odense University Hospital, Odense C, Denmark
- Institute of Clinical Research, University of Southern Denmark, Odense C, Denmark
| | - Katrine Prier Lindvig
- Department of Gastroenterology and Hepatology, Odense University Hospital, Odense C, Denmark
- Institute of Clinical Research, University of Southern Denmark, Odense C, Denmark
| | - Maja Thiele
- Department of Gastroenterology and Hepatology, Odense University Hospital, Odense C, Denmark
- Institute of Clinical Research, University of Southern Denmark, Odense C, Denmark
| | - Laurent Castera
- Service d'Hépatologie, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Beaujon, Clichy, France
- Faculté de Médecine, Université Paris Cité, UMR1149 (CRI), INSERM, Paris, France
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Rivera-Esteban J, Jiménez-Masip A, Muñoz-Martínez S, Augustin S, Guerrero RA, Gabriel-Medina P, Ferrer-Costa R, Rodríguez-Frías F, Turu E, Marco A, Pericàs JM, on behalf of the PRISONAFLD Study Group Collaborators. Prevalence and Risk Factors of MASLD and Liver Fibrosis amongst the Penitentiary Population in Catalonia: The PRISONAFLD Study. J Clin Med 2023; 12:7276. [PMID: 38068330 PMCID: PMC10707608 DOI: 10.3390/jcm12237276] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/19/2023] [Accepted: 11/21/2023] [Indexed: 01/11/2025] Open
Abstract
BACKGROUND AND AIMS The prevalence of chronic non-communicable diseases, particularly metabolic syndrome (MetS), has increased among the prison population. Nevertheless, we have limited data on metabolic dysfunction-associated steatotic liver disease (MASLD), the hepatic manifestation of this syndrome. We aimed to investigate the prevalence and risk factors of MASLD and MASLD-associated liver fibrosis in the penitentiary population in Catalonia, Spain. METHOD A cross-sectional observational study involving eight penitentiary centers. Participants had at least one metabolic disorder and were at a closed-regimen penitentiary. Individuals with concomitant liver diseases and/or alcohol risk consumption were excluded. Significant fibrosis and MASLD were defined as liver stiffness ≥8 kPa and a controlled attenuation parameter ≥275 dB/m by vibration-controlled transient elastography (VCTE), respectively. After exclusions, metabolic inmates with VCTE were analyzed. Logistic regression analysis was performed to identify predictors of MASLD and MASLD-associated significant fibrosis. RESULTS Out of the 4338 inmates studied, 1290 (29.7%) had metabolic disorders, and 646 (14.9%) underwent VCTE. The mean age was 48.0 years (SD 12.1), and 89.5% were male. MASLD prevalence was 33.9%. Significant fibrosis and MASLD-associated significant fibrosis were found in 16.4% and 9.4% of inmates, respectively. In the multivariate analysis, T2D, waist circumference, MetS, and higher ALT values were identified as independent risk factors for MASLD and MASLD-associated significant fibrosis amongst the prison population. CONCLUSIONS Metabolic disorders including MASLD are highly prevalent among inmates. The prevalence of significant fibrosis seems notably higher than that of the general population, underscoring the need for targeted screening programs and therapeutic interventions in the incarcerated population.
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Affiliation(s)
- Jesús Rivera-Esteban
- Liver Unit, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, 08035 Barcelona, Spain; (A.J.-M.); (S.M.-M.); (S.A.)
- Department of Medicine, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain; (P.G.-M.); (R.F.-C.); (F.R.-F.)
| | - Alba Jiménez-Masip
- Liver Unit, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, 08035 Barcelona, Spain; (A.J.-M.); (S.M.-M.); (S.A.)
- Department of Medicine, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain; (P.G.-M.); (R.F.-C.); (F.R.-F.)
| | - Sergio Muñoz-Martínez
- Liver Unit, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, 08035 Barcelona, Spain; (A.J.-M.); (S.M.-M.); (S.A.)
| | - Salvador Augustin
- Liver Unit, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, 08035 Barcelona, Spain; (A.J.-M.); (S.M.-M.); (S.A.)
| | - Rafael A. Guerrero
- Prison Health Program, Catalan Institute of Health, 08908 Barcelona, Spain; (R.A.G.); (E.T.); (A.M.)
| | - Pablo Gabriel-Medina
- Department of Medicine, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain; (P.G.-M.); (R.F.-C.); (F.R.-F.)
- Clinical Biochemistry Department, Vall d’Hebron Hospital Universitari, 08035 Barcelona, Spain
| | - Roser Ferrer-Costa
- Department of Medicine, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain; (P.G.-M.); (R.F.-C.); (F.R.-F.)
- Clinical Biochemistry Department, Vall d’Hebron Hospital Universitari, 08035 Barcelona, Spain
| | - Francisco Rodríguez-Frías
- Department of Medicine, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain; (P.G.-M.); (R.F.-C.); (F.R.-F.)
- Clinical Biochemistry Department, Vall d’Hebron Hospital Universitari, 08035 Barcelona, Spain
| | - Elisabet Turu
- Prison Health Program, Catalan Institute of Health, 08908 Barcelona, Spain; (R.A.G.); (E.T.); (A.M.)
| | - Andrés Marco
- Prison Health Program, Catalan Institute of Health, 08908 Barcelona, Spain; (R.A.G.); (E.T.); (A.M.)
- Ciber de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - Juan M. Pericàs
- Liver Unit, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, 08035 Barcelona, Spain; (A.J.-M.); (S.M.-M.); (S.A.)
- Department of Medicine, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain; (P.G.-M.); (R.F.-C.); (F.R.-F.)
- Centros de Investigación Biomédica en Red, Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain
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