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Kim G, Yu TY, Jee JH, Bae JC, Kang M, Kim JH. Association between nonalcoholic fatty liver disease and left ventricular diastolic dysfunction: A 7-year retrospective cohort study of 3,380 adults using serial echocardiography. DIABETES & METABOLISM 2024; 50:101534. [PMID: 38608865 DOI: 10.1016/j.diabet.2024.101534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 04/05/2024] [Accepted: 04/08/2024] [Indexed: 04/14/2024]
Abstract
AIM Left ventricular diastolic dysfunction (LVDD) has been observed in people with nonalcoholic fatty liver disease (NAFLD) in cross-sectional studies but the causal relationship is unclear. This study aimed to investigate the impact of NAFLD and the fibrotic progression of the disease on the development of LVDD, assessed by serial echocardiography, in a large population over a 7-year longitudinal setting. METHODS This retrospective cohort study included the data of 3,380 subjects from a medical health check-up program. We defined subjects having NAFLD by abdominal ultrasonography and assessed significant liver fibrosis by the aspartate transaminase (AST) to platelet ratio index (APRI), the NAFLD fibrosis score (NFS), and the fibrosis-4 (FIB-4) index. LVDD was defined using serial echocardiography. A parametric Cox proportional hazards model was used. RESULTS During 11,327 person-years of follow-up, there were 560 (16.0 %) incident cases of LVDD. After adjustment for multiple risk factors, subjects with NAFLD showed an increased adjusted hazard ratio (aHR) of 1.21 (95 % confidence interval [CI]=1.02-1.43) for incident LVDD compared to those without. The risk of LV diastolic dysfunction increased progressively with increasing degree of hepatic steatosis (P< 0.001). Compared to subjects without NAFLD, the multivariable-aHR (95 % CI) for LVDD in subjects with APRI < 0.5 and APRI ≥ 0.5 were 1.20 (1.01-1.42) and 1.36 (0.90-2.06), respectively (P= 0.036), while other fibrosis prediction models (NFS and FIB-4 index) showed insignificant results. CONCLUSIONS This study demonstrated that NAFLD was associated with an increased risk of LVDD in a large cohort. More severe forms of hepatic steatosis and/or significant liver fibrosis may increase the risk of developing LVDD.
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Affiliation(s)
- Gyuri Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Tae Yang Yu
- Division of Endocrinology and Metabolism, Department of Medicine, Wonkwang Medical Center, Wonkwang University School of Medicine, Iksan, Republic of Korea
| | - Jae Hwan Jee
- Department of Health Promotion Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ji Cheol Bae
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Mira Kang
- Department of Health Promotion Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Jae Hyeon Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Samsung Biomedical Research Institute, Samsung Medical Center, Seoul, Republic of Korea; Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Republic of Korea.
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2
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Huang S, Bao Y, Zhang N, Niu R, Tian L. Long-term outcomes in lean and non-lean NAFLD patients: a systematic review and meta-analysis. Endocrine 2023:10.1007/s12020-023-03351-5. [PMID: 37253855 DOI: 10.1007/s12020-023-03351-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Although nonalcoholic fatty liver disease (NAFLD) commonly occurs in overweight or obese individuals, it is increasingly being identified in the lean population. The association between lean and an increased risk of all-cause mortality among patients with NAFLD remains controversial. We aimed to perform a systematic review and meta-analysis of the literature to evaluate this association and compare the long-term outcomes of lean NAFLD patients and non-lean NAFLD patients. METHODS For this systematic review and meta-analysis, we searched PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), Wan Fang, and Chinese Biomedical Literature Database (CBM) from inception to October 15, 2021, for relevant original research articles without any language restrictions. Our primary outcome was to compare the all-cause mortality in lean NAFLD patients and non-lean NAFLD patients by qualitative synthesis. Relative risks (RRs) and corresponding 95% confidential intervals (CIs) were pooled with a random effect model. Heterogeneity was evaluated using I-squared (I²) statistics while publication bias was determined using Egger's tests. Subgroup and sensitivity analyses were performed. As for secondary outcomes, we estimated total, cardiovascular, and liver-related mortality, as well as the incidence of diabetes, hypertension, cirrhosis, and cancer in lean and non-lean individuals with NAFLD by quantitative synthesis. Person-years of follow-up were used as the denominator to estimate the mortality and incidence. RESULTS We identified 12 studies (n = 26,329), 7 of which (n = 7924) were used to evaluate the risk of all-cause mortality between lean and non-lean NAFLD patients. Lean patients with NAFLD were found to be at an elevated risk of death compared to non-lean patients (RR = 1.39, 95% CI 1.08-1.82, heterogeneity: I² = 43%). Among the lean NAFLD population, all-cause mortality was 13.3 (95% CI: 6.7-26.1) per 1000 person-years, 3.6 (95% CI: 1.0-11.7) for liver-related mortality, and 7.7 (95% CI: 6.4-9.2) for cardiovascular-related mortality. The incidence of new-onset diabetes was 13.7 (95% CI 8·2-22.7) per 1000 person-years, new-onset hypertension was 56.1 (95% CI: 40.2-77.9), cirrhosis was 2.3 (95% CI: 1.0-5.0), and cancer was 25.7 (95% CI: 20.3-32.4). CONCLUSIONS Lean patients with NAFLD had a higher risk of all-cause death than non-lean patients. Body mass index (BMI) should not be used as a criterion to determine whether further observation and therapy of patients with NAFLD are warranted.
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Affiliation(s)
- Shaomin Huang
- The first Clinical Medical College of Gansu University of Traditional Chinese Medicine, 730000, Lanzhou, China
- Department of Endocrinology, Gansu Provincial Hospital, Lanzhou, 730000, Gansu Province, China
- Gansu Clinical Research Center for Metabolic Diseases, Lanzhou, 730000, Gansu Province, China
| | - Yun Bao
- Institute of Clinical Research and Evidence Based Medicine, Gansu Provincial Hospital, Lanzhou, 730000, Gansu Province, China
| | - Nawen Zhang
- The first Clinical Medical College of Gansu University of Traditional Chinese Medicine, 730000, Lanzhou, China
- Department of Endocrinology, Gansu Provincial Hospital, Lanzhou, 730000, Gansu Province, China
- Gansu Clinical Research Center for Metabolic Diseases, Lanzhou, 730000, Gansu Province, China
| | - Ruilan Niu
- Department of Endocrinology, Gansu Provincial Hospital, Lanzhou, 730000, Gansu Province, China
- Gansu Clinical Research Center for Metabolic Diseases, Lanzhou, 730000, Gansu Province, China
| | - Limin Tian
- Department of Endocrinology, Gansu Provincial Hospital, Lanzhou, 730000, Gansu Province, China.
- Gansu Clinical Research Center for Metabolic Diseases, Lanzhou, 730000, Gansu Province, China.
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3
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Lu R, Liu Y, Hong T. Epidemiological characteristics and management of nonalcoholic fatty liver disease/nonalcoholic steatohepatitis in China: A narrative review. Diabetes Obes Metab 2023; 25 Suppl 1:13-26. [PMID: 36775938 DOI: 10.1111/dom.15014] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/27/2023] [Accepted: 02/08/2023] [Indexed: 02/14/2023]
Abstract
AIM With industrialization and spread of the westernized lifestyle, the number of people affected by non-alcoholic fatty liver disease (NAFLD)/non-alcoholic steatohepatitis (NASH) is growing rapidly in China; this has become a major public health concern. To better understand the burden and characteristics of NAFLD/NASH in China, we aim to perform a narrative review of the literature published in this field. MATERIALS AND METHODS We carried out a comprehensive electronic search of five English-language and three Chinese-language databases, to identify studies regarding NAFLD or NASH published from inception to November 30, 2022. Epidemiological studies of NAFLD/NASH in China were particularly noticed and summarized. We also searched the www. CLINICALTRIALS gov and www.chictr.org.cn websites for the registered trials on the treatment of the disease led by Chinese investigators or located in China. RESULTS The increasing rate of NAFLD prevalence in China is strikingly high, reaching more than twice that in western countries. The prevalence of NAFLD is nearly 30% of the general Chinese population, making it the leading cause of chronic liver diseases. The prevalence of NAFLD/NASH varies between provinces/regions, age groups, sexes, and individuals with different metabolic profiles. NAFLD co-exists in many Chinese patients with chronic hepatitis B. Since 2020, more Chinese studies have used the term metabolic-associated fatty liver disease (MAFLD), emphasizing the underlying metabolic disorders that occur concurrently with this disease. Several clinical trials involving lifestyle interventions, antidiabetic drugs, or traditional Chinese medicines, registered by Chinese investigators, have been completed or are ongoing. Moreover, several innovative targeted therapies developed in China are revolutionizing the treatment of NAFLD/NASH. CONCLUSIONS NAFLD has cast a heavy burden on the Chinese healthcare system. Chinese scholars are making efforts to achieve the optimal management of this disease.
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Affiliation(s)
- Ran Lu
- Department of Endocrinology and Metabolism, Peking University Third Hospital, Beijing, China
| | - Ye Liu
- Department of Endocrinology and Metabolism, Peking University Third Hospital, Beijing, China
| | - Tianpei Hong
- Department of Endocrinology and Metabolism, Peking University Third Hospital, Beijing, China
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4
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Lee J, Mulder F, Leeflang M, Wolff R, Whiting P, Bossuyt PM. QUAPAS: An Adaptation of the QUADAS-2 Tool to Assess Prognostic Accuracy Studies. Ann Intern Med 2022; 175:1010-1018. [PMID: 35696685 DOI: 10.7326/m22-0276] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Whereas diagnostic tests help detect the cause of signs and symptoms, prognostic tests assist in evaluating the probable course of the disease and future outcome. Studies to evaluate prognostic tests are longitudinal, which introduces sources of bias different from those for diagnostic accuracy studies. At present, systematic reviews of prognostic tests often use the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies 2) tool to assess risk of bias and applicability of included studies because no equivalent instrument exists for prognostic accuracy studies. QUAPAS (Quality Assessment of Prognostic Accuracy Studies) is an adaptation of QUADAS-2 for prognostic accuracy studies. Questions likely to identify bias were evaluated in parallel and collated from QUIPS (Quality in Prognosis Studies) and PROBAST (Prediction Model Risk of Bias Assessment Tool) and paired to the corresponding question (or domain) in QUADAS-2. A steering group conducted and reviewed 3 rounds of modifications before arriving at the final set of domains and signaling questions. QUAPAS follows the same steps as QUADAS-2: Specify the review question, tailor the tool, draw a flow diagram, judge risk of bias, and identify applicability concerns. Risk of bias is judged across the following 5 domains: participants, index test, outcome, flow and timing, and analysis. Signaling questions assist the final judgment for each domain. Applicability concerns are assessed for the first 4 domains. The authors used QUAPAS in parallel with QUADAS-2 and QUIPS in a systematic review of prognostic accuracy studies. QUAPAS improved the assessment of the flow and timing domain and flagged a study at risk of bias in the new analysis domain. Judgment of risk of bias in the analysis domain was challenging because of sparse reporting of statistical methods.
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Affiliation(s)
- Jenny Lee
- Department of Epidemiology and Data Science, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands (J.L., M.L., P.M.B.)
| | - Frits Mulder
- Department of Vascular Medicine, Cardiovascular Sciences, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands (F.M.)
| | - Mariska Leeflang
- Department of Epidemiology and Data Science, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands (J.L., M.L., P.M.B.)
| | - Robert Wolff
- Kleijnen Systematic Reviews, Escrick, United Kingdom (R.W.)
| | - Penny Whiting
- Bristol Medical School, University of Bristol, Bristol, United Kingdom (P.W.)
| | - Patrick M Bossuyt
- Department of Epidemiology and Data Science, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands (J.L., M.L., P.M.B.)
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5
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Naeem M, Markus MRP, Mousa M, Schipf S, Dörr M, Steveling A, Aghdassi A, Kühn JP, Kromrey ML, Nauck M, Targher G, Völzke H, Ittermann T. Associations of liver volume and other markers of hepatic steatosis with all-cause mortality in the general population. Liver Int 2022; 42:575-584. [PMID: 34894052 DOI: 10.1111/liv.15133] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 12/02/2021] [Accepted: 12/03/2021] [Indexed: 12/15/2022]
Abstract
AIMS We examined the associations between liver volume and other quantitative and qualitative markers of hepatic steatosis with all-cause mortality in the general population. METHODS We included 2769 German middle-aged individuals with a median follow-up of 8.9 years (23,898 person-years). Quantitative markers used were serum liver enzymes and FIB-4 score, while qualitative markers of hepatic steatosis included magnetic resonance imaging (MRI) measurements of liver fat content and total liver volume. Cox proportional hazards models, adjusted for confounding factors, were undertaken to investigate the associations of liver volume and other markers of hepatic steatosis with all-cause mortality. RESULTS A larger MRI-assessed liver volume was associated with a nearly three-fold increased risk of all-cause mortality (Hazard Ratio = 3.16; 95% confidence interval 1.88; 5.30), independent of age, sex, body mass index, food frequency score, alcohol consumption and education level. This association was consistent in all subgroups considered (men vs. women; presence or absence of overweight/obesity, metabolic syndrome or diabetes). Higher serum liver enzyme levels and FIB-4 score were also significantly associated with higher all-cause mortality in the total population and in all subgroups. No independent associations were found between other quantitative and qualitative markers of hepatic steatosis and the risk of all-cause mortality. CONCLUSIONS We showed for the first time that larger liver volume was associated with a three-fold increase in long-term risk of all-cause mortality. This association remained significant after adjustment for age, sex, alcohol consumption, obesity and other coexisting metabolic disorders.
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Affiliation(s)
- Muhammad Naeem
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany.,Department of Zoology, University of Malakand, Chakdara, Pakistan
| | - Marcello R P Markus
- Department of Internal Medicine B - Cardiology, Intensive Care, Pulmonary Medicine and Infectious Diseases, University Medicine Greifswald, Greifswald, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
| | - Mohammed Mousa
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Sabine Schipf
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Marcus Dörr
- Department of Internal Medicine B - Cardiology, Intensive Care, Pulmonary Medicine and Infectious Diseases, University Medicine Greifswald, Greifswald, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
| | - Antje Steveling
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Ali Aghdassi
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Jens-Peter Kühn
- Institute and Policlinic for Diagnostic and Interventional Radiology, University Hospital, Carl Gustav Carus University, Dresden, Germany
| | - Marie-Luise Kromrey
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - Matthias Nauck
- Institute for Laboratory Medicine and Clinical Chemistry, University Medicine Greifswald, Greifswald, Germany
| | - Giovanni Targher
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona, Verona, Italy
| | - Henry Völzke
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany.,DZD (German Center for Diabetes Research), Site Greifswald, Greifswald, Germany
| | - Till Ittermann
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
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6
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Liu CH, Ampuero J, Pavlides M, Wong VWS, Fan JG, Bai L, Li H, Wu DB, Zhou LY, Du LY, Yang TK, Jiang W, Shi Y, Gil-Gómez A, Zhang WT, Liang JX, Romero-Gómez M, Tang H. Simple non-invasive scoring systems and histological scores in predicting mortality in patients with non-alcoholic fatty liver disease: A systematic review and meta-analysis. J Gastroenterol Hepatol 2021; 36:1754-1768. [PMID: 33569851 DOI: 10.1111/jgh.15431] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 12/24/2020] [Accepted: 01/31/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIM There is debate among the hepatology community regarding the simple non-invasive scoring systems and histological scores (even it was developed for histological classification) in predicting clinical outcomes in patients with non-alcoholic fatty liver disease (NAFLD). This study aimed to determine whether the presence of simple non-invasive scoring systems and histological scores could predict all-cause mortality, liver-related mortality, and liver disease decompensation (liver failure, cirrhosis, hepatocellular carcinoma, or decompensated liver disease). METHODS The pooled hazard ratio of prognostic factors and incidence rate per 1000 person-years in patients with NAFLD was calculated and further adjusted by two different models of handling the duplicated data. RESULTS A total of 19 longitudinal studies were included. Most simple non-invasive scoring systems (Fibrosis-4 Score, BARD, and aspartate aminotransferase-to-platelet ratio index ) and histological scores (NAFLD activity score, Brunt, and "steatosis, activity, and fibrosis" ) failed in predicting mortality, and only the NAFLD fibrosis score > 0.676 showed prognostic ability to all-cause mortality (four studies, 7564 patients, 118 352 person-years followed up, pooled hazard ratio 1.44, 95% confidence interval [CI] 1.05-1.96). The incidence rate per 1000 person-years of all-cause mortality, liver-related mortality, cardiovascular-related mortality, and liver disease decompensation resulted in a pooled incidence rate per 1000 person-years of 22.65 (14 studies, 95% CI 9.62-53.31), 3.19 (7 studies, 95% CI 1.14-8.93), 6.02 (6 studies, 95% CI 4.69-7.74), and 11.46 (4 studies, 95% CI 5.33-24.63), respectively. CONCLUSION Non-alcoholic fatty liver disease fibrosis score showed promising prognostic value to all-cause mortality. Most present simple non-invasive scoring systems and histological scores failed to predict clinical outcomes.
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Affiliation(s)
- Chang-Hai Liu
- Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, China.,Division of Infectious Diseases, State Key Laboratory of Biotherapy and Center of Infectious Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Javier Ampuero
- Digestive Diseases Unit, Virgen del Rocío University Hospital, SeLiver Group at Institute of Biomedicine of Seville (IBIS), University of Seville, Seville, Spain
| | - Michael Pavlides
- Oxford NIHR Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust and the University of Oxford, Oxford, UK
| | - Vincent Wai-Sun Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Jian-Gao Fan
- Department of Gastroenterology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lang Bai
- Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, China.,Division of Infectious Diseases, State Key Laboratory of Biotherapy and Center of Infectious Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Hong Li
- Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, China.,Division of Infectious Diseases, State Key Laboratory of Biotherapy and Center of Infectious Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Dong-Bo Wu
- Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, China.,Division of Infectious Diseases, State Key Laboratory of Biotherapy and Center of Infectious Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Ling-Yun Zhou
- Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, China.,Division of Infectious Diseases, State Key Laboratory of Biotherapy and Center of Infectious Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Ling-Yao Du
- Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, China.,Division of Infectious Diseases, State Key Laboratory of Biotherapy and Center of Infectious Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Tian-Kuo Yang
- Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, China.,Division of Infectious Diseases, State Key Laboratory of Biotherapy and Center of Infectious Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Wei Jiang
- Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, China.,Division of Infectious Diseases, State Key Laboratory of Biotherapy and Center of Infectious Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Ying Shi
- Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, China.,Division of Infectious Diseases, State Key Laboratory of Biotherapy and Center of Infectious Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Antonio Gil-Gómez
- Digestive Diseases Unit, Virgen del Rocío University Hospital, SeLiver Group at Institute of Biomedicine of Seville (IBIS), University of Seville, Seville, Spain
| | - Wen-Ting Zhang
- Digestive Diseases Unit, Virgen del Rocío University Hospital, SeLiver Group at Institute of Biomedicine of Seville (IBIS), University of Seville, Seville, Spain
| | - Jia-Xu Liang
- Digestive Diseases Unit, Virgen del Rocío University Hospital, SeLiver Group at Institute of Biomedicine of Seville (IBIS), University of Seville, Seville, Spain
| | - Manuel Romero-Gómez
- Digestive Diseases Unit, Virgen del Rocío University Hospital, SeLiver Group at Institute of Biomedicine of Seville (IBIS), University of Seville, Seville, Spain
| | - Hong Tang
- Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, China.,Division of Infectious Diseases, State Key Laboratory of Biotherapy and Center of Infectious Disease, West China Hospital, Sichuan University, Chengdu, China
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7
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Sumida Y, Yoneda M, Tokushige K, Kawanaka M, Fujii H, Yoneda M, Imajo K, Takahashi H, Eguchi Y, Ono M, Nozaki Y, Hyogo H, Koseki M, Yoshida Y, Kawaguchi T, Kamada Y, Okanoue T, Nakajima A. FIB-4 First in the Diagnostic Algorithm of Metabolic-Dysfunction-Associated Fatty Liver Disease in the Era of the Global Metabodemic. Life (Basel) 2021; 11:143. [PMID: 33672864 PMCID: PMC7917687 DOI: 10.3390/life11020143] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 01/22/2021] [Accepted: 01/25/2021] [Indexed: 12/16/2022] Open
Abstract
The prevalence of obesity or metabolic syndrome is increasing worldwide (globally metabodemic). Approximately 25% of the adult general population is suffering from nonalcoholic fatty liver disease (NAFLD), which has become a serious health problem. In 2020, global experts suggested that the nomenclature of NAFLD should be updated to metabolic-dysfunction-associated fatty liver disease (MAFLD). Hepatic fibrosis is the most significant determinant of all cause- and liver -related mortality in MAFLD. The non-invasive test (NIT) is urgently required to evaluate hepatic fibrosis in MAFLD. The fibrosis-4 (FIB-4) index is the first triaging tool for excluding advanced fibrosis because of its accuracy, simplicity, and cheapness, especially for general physicians or endocrinologists, although the FIB-4 index has several drawbacks. Accumulating evidence has suggested that vibration-controlled transient elastography (VCTE) and the enhanced liver fibrosis (ELF) test may become useful as the second step after triaging by the FIB-4 index. The leading cause of mortality in MAFLD is cardiovascular disease (CVD), extrahepatic malignancy, and liver-related diseases. MAFLD often complicates chronic kidney disease (CKD), resulting in increased simultaneous liver kidney transplantation. The FIB-4 index could be a predictor of not only liver-related mortality and incident hepatocellular carcinoma, but also prevalent and incident CKD, CVD, and extrahepatic malignancy. Although NITs as milestones for evaluating treatment efficacy have never been established, the FIB-4 index is expected to reflect histological hepatic fibrosis after treatment in several longitudinal studies. We here review the role of the FIB-4 index in the management of MAFLD.
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Affiliation(s)
- Yoshio Sumida
- Division of Hepatology and Pancreatology, Department of Internal Medicine, Aichi Medical University, Nagakute, Aichi 480-1195, Japan;
| | - Masashi Yoneda
- Division of Hepatology and Pancreatology, Department of Internal Medicine, Aichi Medical University, Nagakute, Aichi 480-1195, Japan;
| | - Katsutoshi Tokushige
- Department of Internal Medicine, Institute of Gastroenterology, Tokyo Women’s Medical University, Tokyo 162-8666, Japan;
| | - Miwa Kawanaka
- Department of General Internal Medicine2, Kawasaki Medical School, Okayama 700-8505, Japan;
| | - Hideki Fujii
- Department of Hepatology, Graduate School of Medicine, Osaka City University, Osaka 558-8585, Japan;
| | - Masato Yoneda
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Yokohama City University, Yokohama 236-0004, Japan; (M.Y.); (K.I.); (A.N.)
| | - Kento Imajo
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Yokohama City University, Yokohama 236-0004, Japan; (M.Y.); (K.I.); (A.N.)
| | - Hirokazu Takahashi
- Department of Metabolism and Endocrinology, Faculty of Medicine, Saga University, Saga 840-8502, Japan;
| | | | - Masafumi Ono
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tokyo Women’s Medical University Medical Center East, Tokyo 116-8567, Japan;
| | - Yuichi Nozaki
- Department of Gastroenterology, National Center for Global Health and Medicine, Tokyo 162-8655, Japan;
| | - Hideyuki Hyogo
- Department of Gastroenterology, JA Hiroshima General Hospital, Hiroshima 738-8503, Japan;
| | - Masahiro Koseki
- Division of Cardiovascular Medicine, Department of Medicine, Graduate School of Medicine, Osaka University, Suita, Osaka 565-0871, Japan;
| | - Yuichi Yoshida
- Department of Gastroenterology and Hepatology, Suita Municipal Hospital, Osaka 564-8567, Japan;
| | - Takumi Kawaguchi
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume 830-0011, Japan;
| | - Yoshihiro Kamada
- Department of Advanced Gastroenterology & Hepatology, Graduate School of Medicine, Osaka University, Suita, Osaka 565-0871, Japan;
| | - Takeshi Okanoue
- Hepatology Center, Saiseikai Suita Hospital, Osaka 564-0013, Japan;
| | - Atsushi Nakajima
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Yokohama City University, Yokohama 236-0004, Japan; (M.Y.); (K.I.); (A.N.)
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8
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Hernandez Roman J, Siddiqui MS. The role of noninvasive biomarkers in diagnosis and risk stratification in nonalcoholic fatty liver disease. Endocrinol Diabetes Metab 2020; 3:e00127. [PMID: 33102796 PMCID: PMC7576290 DOI: 10.1002/edm2.127] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 02/28/2020] [Accepted: 02/29/2020] [Indexed: 02/06/2023] Open
Abstract
Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronically elevated liver enzymes. Diagnosis and risk stratification of NAFLD remains clinically challenge as patients with NAFLD are either asymptomatic or have nonspecific presenting complaints and may have normal liver enzymes. Nonalcoholic steatohepatitis (NASH), the clinically aggressive variant of NAFLD, is also difficult to differentiate noninvasively, and a liver biopsy is required to definitively diagnose NASH. Thus, the definitive diagnosis and risk stratification of NAFLD is embedded in histological assessment of the liver. Several clinical aides been investigated in an attempt to risk stratify and identify patients noninvasively as doing a liver biopsy in all patients with NAFLD are not feasible. Since these biomarkers are unable to differentiate NASH from non-NASH, they have leveraged biochemical changes within the liver as patients progress to varying degree of hepatic fibrosis to identify patients with moderate fibrosis (fibrosis stage 2 or greater) and advanced fibrosis (fibrosis stage 3 or greater) to help guide the need for additional and more definitive workup. These clinical aides span from by-products of apoptosis to statistical modelling of clinically available data to identify 'at-risk' patients with NAFLD. The current review will focus the diagnostic performance of these noninvasive serum-based biomarkers in NAFLD.
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Affiliation(s)
| | - Mohammad S. Siddiqui
- Division of Gastroenterology, Hepatology and NutritionDepartment of Internal MedicineVirginia Commonwealth University (VCU)RichmondVirginia
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Yousefi M, Shadnoush M, Khorshidian N, Mortazavian AM. Insights to potential antihypertensive activity of berry fruits. Phytother Res 2020; 35:846-863. [PMID: 32959938 DOI: 10.1002/ptr.6877] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 08/11/2020] [Accepted: 08/24/2020] [Indexed: 12/11/2022]
Abstract
Hypertension is one of the main risk factors for cardiovascular disease and causes widespread morbidity and mortality worldwide. Although several antihypertensive drugs have been proposed for management of high blood pressure, changing lifestyle, including diet, has attracted interest recently. In this sense, consumption of fruits and vegetables, which are rich in vitamins, minerals, and phytochemicals, has been assigned as an efficient therapeutics. Berry fruits contain various bioactive compounds with potential health implications such as antioxidant, antimicrobial, anticancer, and anti-inflammatory properties. The main mechanisms responsible for antihypertensive activity mainly arise from the activity of flavonoids, minerals, and vitamins, as well as fibers. The objective of this review is to provide a summary of studies regarding the effect of berry fruits on the hypertensive animals and humans. The mechanisms involved in reducing blood pressure by each group of compounds have been highlighted. It can be concluded that berries' bioactive compounds are efficient in mitigation of hypertension through improvement of vascular function, angiotensin-converting enzyme's (ACE) inhibitory activity, increasing endothelial nitric oxide synthase (eNOS) activity, and nitric oxide (NO) production, besides anti-oxidative and anti-inflammatory activities. These fruits can be considered as potential sources of invaluable compounds for development of antihypertensive foods and pharmaceuticals.
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Affiliation(s)
- Mojtaba Yousefi
- Food Safety Research Center (Salt), Semnan University of Medical Sciences, Semnan, Iran
| | - Mahdi Shadnoush
- Department of Clinical Nutrition, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nasim Khorshidian
- Food Safety Research Center (Salt), Semnan University of Medical Sciences, Semnan, Iran
| | - Amir M Mortazavian
- Food Safety Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Ahmed HS, Pedersen N, Jayanna MB, Ten Eyck P, Sanchez A, Murali AR. Predictive Factors and Time to Development of Hepatic Decompensation in Patients with Non-alcoholic Fatty Liver Disease. J Gen Intern Med 2020; 35:1523-1529. [PMID: 32157645 PMCID: PMC7210346 DOI: 10.1007/s11606-020-05725-1] [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: 07/17/2019] [Accepted: 02/10/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) is one of the most common causes of cirrhosis in the USA. OBJECTIVES We aimed to determine the time to develop hepatic events in patients with NAFLD and develop a simple model to identify patients at risk for hepatic decompensation. DESIGN Retrospective cohort study. PATIENTS Seven hundred patients with NAFLD met inclusion criteria for the study. Patients were divided into model construction (n = 450) and validation (n = 250) cohorts. MAIN MEASURES Demographic, clinical, and laboratory variables were gathered at the time of diagnosis of NAFLD. Kaplan-Meier analysis determined the time to development of hepatic events from initial diagnosis. A time-to-event prediction model was established in the model construction cohort using the multivariate Cox proportional hazards model and was then internally validated. KEY RESULTS Forty-nine (7%) patients developed hepatic events at a mean duration of 6.2 ± 4.2 years from initial diagnosis. Kaplan-Meier probability of developing a hepatic event at 5-, 10-, and 12-year intervals was 4.8%, 10.6%, and 11.3%, respectively. Age, presence of diabetes, and platelet count were identified as significant variables to predict hepatic events. NAFLD decompensation risk score was developed as "age × 0.06335 + presence of diabetes (yes = 1, no = 0) × 0.92221 - platelet count × 0.01522" to predict the probability of hepatic decompensation. Risk score model had an area under the curve of 0.89 (95% CI = 0.92, 0.86) and it performed well in both the validation (0.91, 0.87-0.94) and the overall cohort (0.89, 0.87-0.91). CONCLUSIONS A significant proportion of patients with NAFLD developed hepatic decompensation. We have provided a simple, objective model to help identify "at-risk" patients.
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Affiliation(s)
- Heidi S Ahmed
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA. .,Division of Gastroenterology and Hepatology, Boston University Medical Center, 85 E. Concord Street, Boston, MA, 02118, USA.
| | - Natalie Pedersen
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Manju Bengaluru Jayanna
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.,Lankenau Institute for Medical Research, Wynnewood, PA, USA
| | - Patrick Ten Eyck
- Biostatistics and Research Design, Institute of Clinical and Translational Science, University of Iowa, Iowa City, IA, USA
| | - Antonio Sanchez
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Arvind R Murali
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.,Division of Gastroenterology and Hepatology, The University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52240, USA
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11
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Caruso MG, Veronese N, Notarnicola M, Cisternino AM, Reddavide R, Inguaggiato R, Guerra V, Donghia R, Logroscino A, Rotolo O, Chiloiro M, Leandro G, De Leonardis G, Tutino V, Misciagna G, Bonfiglio C, Guerra R, Osella A. Fatty liver and mortality: a cohort population study in South Italy. BMJ Open 2019; 9:e027379. [PMID: 31227533 PMCID: PMC6596964 DOI: 10.1136/bmjopen-2018-027379] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE Alcoholic fatty liver (AFLD) and non-alcoholic fatty liver (NAFLD) are two common conditions. However, if they can increase the risk of death is poorly explored. We therefore aimed to investigate the potential association between the presence and severity of liver steatosis and mortality in a large sample of older people. DESIGN Prospective. SETTING Community. PARTICIPANTS Women and men randomly sampled from the electoral rolls of the population of Castellana Grotte, a town in Southern Italy (Apulia region) between 2005 and 2006. Among 1942 initially contacted, 1708 (=87.9%) participated to the baseline survey (Multicentrica Colelitiasi III (MICOL III)). This specific study included 1445 older participants (mean age=65.2 years, females=44.2%). EXPOSURE NAFLD or AFLD. PRIMARY AND SECONDARY OUTCOMES Mortality (all-cause and specific-cause). RESULTS After a median of 12 years, 312 participants (=21.6%) died. After adjusting for nine potential confounders, the presence of steatosis was not associated with any increased risk of death in both NAFLD and AFLD. The severity of liver steatosis was not associated with any increased risk of mortality in NAFLD, while in AFLD, the presence of moderate steatosis significantly increased the risk of overall (HR=2.16; 95% CI 1.19 to 3.91) and cancer-specific (HR=3.54; 95% CI 1.16 to 10.87) death. CONCLUSIONS Liver steatosis is not associated with any increased risk of death in NAFLD, while moderate steatosis could be a risk factor for mortality (particularly due to cancer) in people affected by AFLD.
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Affiliation(s)
- Maria Gabriella Caruso
- Laboratory of Nutritional Biochemistry, National Institute of Gastroenterology-Research Hospital, IRCCS "Saverio de Bellis", Castellana Grotte, Italy
- Ambulatory of Clinical Nutrition, National Institute of Gastroenterology-Research Hospital, IRCCS "Saverio de Bellis", Castellana Grotte, Italy
| | - Nicola Veronese
- Istituto di Neuroscienze Consiglio Nazionale delle Ricerche, Padova, Italy
| | - Maria Notarnicola
- Laboratory of Nutritional Biochemistry, National Institute of Gastroenterology-Research Hospital, IRCCS "Saverio de Bellis", Castellana Grotte, Italy
| | - Anna Maria Cisternino
- Ambulatory of Clinical Nutrition, National Institute of Gastroenterology-Research Hospital, IRCCS "Saverio de Bellis", Castellana Grotte, Italy
| | - Rosa Reddavide
- Ambulatory of Clinical Nutrition, National Institute of Gastroenterology-Research Hospital, IRCCS "Saverio de Bellis", Castellana Grotte, Italy
| | - Rosa Inguaggiato
- Ambulatory of Clinical Nutrition, National Institute of Gastroenterology-Research Hospital, IRCCS "Saverio de Bellis", Castellana Grotte, Italy
| | - Vito Guerra
- Clinical Trial Unit, National Institute of Gastroenterology-Research Hospital, IRCCS "Saverio de Bellis", Castellana Grotte, Italy
| | - Rossella Donghia
- Clinical Trial Unit, National Institute of Gastroenterology-Research Hospital, IRCCS "Saverio de Bellis", Castellana Grotte, Italy
| | - Antonio Logroscino
- I.R.C.C.S. "Giovanni Paolo II", Thoracic Medical Oncology, Castellana Grotte, Italy
| | - Ornella Rotolo
- Ambulatory of Clinical Nutrition, National Institute of Gastroenterology-Research Hospital, IRCCS "Saverio de Bellis", Castellana Grotte, Italy
| | - Marisa Chiloiro
- Radiology Unit, National Institute for Digestive Disease, National Institute of Gastroenterology-Research Hospital, IRCCS "Saverio de Bellis", Castellana Grotte, Italy
| | - Gioacchino Leandro
- Gastroenterological Hospital, National Institute of Gastroenterology-Research Hospital, IRCCS "Saverio de Bellis", Castellana Grotte, Italy
| | - Giampiero De Leonardis
- Laboratory of Nutritional Biochemistry, National Institute of Gastroenterology-Research Hospital, IRCCS "Saverio de Bellis", Castellana Grotte, Italy
- Ambulatory of Clinical Nutrition, National Institute of Gastroenterology-Research Hospital, IRCCS "Saverio de Bellis", Castellana Grotte, Italy
| | - Valeria Tutino
- Laboratory of Nutritional Biochemistry, National Institute of Gastroenterology-Research Hospital, IRCCS "Saverio de Bellis", Castellana Grotte, Italy
| | - G Misciagna
- Epidemiology, National Institute of Gastroenterology-Research Hospital, IRCCS "Saverio de Bellis", Castellana Grotte, Italy
| | - Caterina Bonfiglio
- Laboratory of Biostatistics and Epidemiology, IRCCS "Saverio de Bellis", Castellana Grotte, Italy
| | - Rocco Guerra
- Laboratory of Biostatistics and Epidemiology, IRCCS "Saverio de Bellis", Castellana Grotte, Italy
| | - Alberto Osella
- Laboratory of Biostatistics and Epidemiology, IRCCS "Saverio de Bellis", Castellana Grotte, Italy
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Godos J, Vitale M, Micek A, Ray S, Martini D, Del Rio D, Riccardi G, Galvano F, Grosso G. Dietary Polyphenol Intake, Blood Pressure, and Hypertension: A Systematic Review and Meta-Analysis of Observational Studies. Antioxidants (Basel) 2019; 8:antiox8060152. [PMID: 31159186 PMCID: PMC6616647 DOI: 10.3390/antiox8060152] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 05/23/2019] [Accepted: 05/24/2019] [Indexed: 12/12/2022] Open
Abstract
Background: Dietary polyphenols, including flavonoids, have been the focus of major recent attentions due to their wide content in a variety of foods commonly consumed and the findings from numerous studies showing evidence of an association with positive outcomes on human health. Methods: A systematic search using electronic databases PubMed and EMBASE was performed to retrieve English language studies published from the earliest indexing year of each database to April 2019, reporting on the association between dietary flavonoids intake and hypertension. Results: The search strategy resulted in the final selection of 20 studies including 15 cross-sectional investigations and 7 prospective cohorts (1 study reported on 3 prospective cohorts). 5 prospective cohorts, comprising 200,256 individuals and 45,732 cases of hypertension were included in the quantitative analysis. Analysis by extreme quantiles of intake of flavonoid showed a non-significant association with decreased risk of hypertension (RR (risk ratio): 0.96, 95% CI (confidence interval): 0.89, 1.03). Taking into consideration individual flavonoid subclasses, dietary anthocyanins intake was associated with 8% reduction in risk of hypertension, when comparing highest vs. lowest exposure (RR: 0.92, 95% CI: 0.88, 0.97). Conclusions: Further studies are needed to strengthen the retrieved association between anthocyanins consumption and decreased risk of hypertension and clarify whether total flavonoids or rather individual subclasses may exert beneficial effects on blood pressure.
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Affiliation(s)
- Justyna Godos
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy.
- NNEdPro Global Centre for Nutrition and Health, St John's Innovation Centre, Cambridge CB4 0WS, UK; Wolfson College at the University of Cambridge, Cambridge CB3 9BB, UK; Nutrition Innovation Centre for Food and Health at Ulster University, Coleraine BT52 1SA, UK.
| | - Marilena Vitale
- Department of Clinical Medicine and Surgery, "Federico II" University, 80131 Naples, Italy.
| | - Agnieszka Micek
- Department of Nursing Management and Epidemiology Nursing, Faculty of Health Sciences, Jagiellonian University Medical College, 31-501 Krakow, Poland.
| | - Sumantra Ray
- NNEdPro Global Centre for Nutrition and Health, St John's Innovation Centre, Cambridge CB4 0WS, UK; Wolfson College at the University of Cambridge, Cambridge CB3 9BB, UK; Nutrition Innovation Centre for Food and Health at Ulster University, Coleraine BT52 1SA, UK.
- Medical Research Council (MRC) Human Nutrition Research Unit, Cambridge CB1 9NL, UK.
| | - Daniela Martini
- The Laboratory of Phytochemicals in Physiology, Department of Veterinary Science, University of Parma, 43126 Parma, Italy.
| | - Daniele Del Rio
- NNEdPro Global Centre for Nutrition and Health, St John's Innovation Centre, Cambridge CB4 0WS, UK; Wolfson College at the University of Cambridge, Cambridge CB3 9BB, UK; Nutrition Innovation Centre for Food and Health at Ulster University, Coleraine BT52 1SA, UK.
- The Laboratory of Phytochemicals in Physiology, Department of Veterinary Science, University of Parma, 43126 Parma, Italy.
| | - Gabriele Riccardi
- Department of Clinical Medicine and Surgery, "Federico II" University, 80131 Naples, Italy.
| | - Fabio Galvano
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy.
| | - Giuseppe Grosso
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy.
- NNEdPro Global Centre for Nutrition and Health, St John's Innovation Centre, Cambridge CB4 0WS, UK; Wolfson College at the University of Cambridge, Cambridge CB3 9BB, UK; Nutrition Innovation Centre for Food and Health at Ulster University, Coleraine BT52 1SA, UK.
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Heavener T, Memon A, Khan S, Davis S, Sager L, DeMorrow S, Jeffries M. Testing the ability of the nonalcoholic fatty liver disease fibrosis score to predict 1-year all-cause hospital admission. Proc (Bayl Univ Med Cent) 2019; 32:26-29. [PMID: 30956575 DOI: 10.1080/08998280.2018.1543227] [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: 08/03/2018] [Revised: 10/27/2018] [Accepted: 10/29/2018] [Indexed: 10/27/2022] Open
Abstract
The nonalcoholic fatty liver disease fibrosis score (NFS) has been shown to be a cost-effective screening strategy in the primary care setting to determine when gastroenterology referral is needed, but NFS as a predictor of hospitalization within 1 year is uncertain. This retrospective observational cohort study involved 1803 patients with a diagnosis of nonalcoholic fatty liver disease or nonalcoholic steatohepatitis. The NFS was categorized into the following: low (less than -1.455), moderate (between -1.455 and 0.676), and high (>0.676). The average NFS score by hospital admission was -0.760, the average number of admissions was 1.81, and the median number of days to hospital admission was 135.8 days (45.5-363, 25th to 75th percentile). A univariate logistic regression model showed that NFS significantly predicted hospital admission (P = 0.007); however, a multivariate logistic regression model, after adjusting for hypertension and tobacco use, indicated that NFS was not significantly associated with hospital admission. Using the logistic regression model, hypertension predicted admission at low (P < 0.0001) and moderate (P = 0.0005) NFS. Using this same model, tobacco use also predicted admission at low (P < 0.0001) and moderate (P = 0.0002) NFS. The NFS should not be used to determine which patients are at increased risk of hospitalization.
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Affiliation(s)
- Trace Heavener
- Department of Medicine, Division of Internal Medicine, Scott & White Medical Center-TempleTempleTexas
| | - Ahmed Memon
- College of Medicine, Texas A&M UniversityTempleTexas
| | - Shamyal Khan
- Department of Medicine, Division of Internal Medicine, Scott & White Medical Center-TempleTempleTexas
| | - Sam Davis
- Department of Medicine, Division of Internal Medicine, Scott & White Medical Center-TempleTempleTexas
| | - Lauren Sager
- Office of Biostatistics, Baylor Scott & White Research Institute-TempleTempleTexas
| | - Sharon DeMorrow
- Department of Medical Physiology, College of Medicine, Texas A&M University, and Research Biologist, Central Texas Veterans Healthcare SystemTempleTexas
| | - Mark Jeffries
- Department of Medicine, Division of Gastroenterology, Scott & White Medical Center-TempleTempleTexas
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Simple Scores of Fibrosis and Mortality in Patients with NAFLD: A Systematic Review with Meta-Analysis. J Clin Med 2018; 7:jcm7080219. [PMID: 30111756 PMCID: PMC6111765 DOI: 10.3390/jcm7080219] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 08/04/2018] [Accepted: 08/11/2018] [Indexed: 12/16/2022] Open
Abstract
Noninvasive simple scores have been validated to assess advanced liver fibrosis in patients with nonalcoholic fatty liver disease (NAFLD). We performed a systematic review with meta-analysis evaluating if NAFLD fibrosis score (NFS), AST to platelet ratio index (APRI), and Fibrosis-4 (FIB-4) score may also predict mortality. PubMed and EMBASE databases were searched until April 2018. Random-effects models were used to calculate pooled RRs of mortality for highest vs. lowest categories of exposure and to perform dose-response meta-analysis. Heterogeneity was assessed using the Q test and I2 statistic. Overall, eight studies were included in the systematic review; all of the eight studies provided data for NFS, while four provided data for APRI and FIB-4. When comparing the risk estimates for high (>0.676) vs. intermediate + low NFS (≤0.676), we found a nearly fourfold increase in mortality risk, with evidence of heterogeneity (RR = 3.85, 95% CI: 2.08, 7.11; I2 = 92%). At dose-response meta-analysis, compared to the midpoint of the lowest category of NFS (−2.5), the risk of mortality was about twofold higher for NFS = −0.5 (RR = 2.20, 95% CI: 1.31, 3.70) and more than fivefold higher for NFS = 1.5 (RR = 5.16, 95% CI: 2.02, 13.16). When comparing the risk estimates for high (>1.5) vs. medium + low APRI (≤1.5), we found a higher risk of mortality, without heterogeneity (RR = 3.61, 95% CI: 1.79, 7.28; I2 = 0%). Comparison of the risk estimates for high (>2.67) vs. medium + low FIB-4 (≤2.67) didn’t reveal a significantly higher risk of mortality, with heterogeneity (RR = 2.27, 95% CI: 0.72, 7.15; I2 = 85%). Dose-response analysis for APRI and FIB-4 was not considered conclusive due to the low number of studies. Based on the results of our meta-analysis, the measurement of NFS can be considered an accurate tool for the stratification of the risk of death in patients with NAFLD.
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Characterization of transcriptional modules related to fibrosing-NAFLD progression. Sci Rep 2017; 7:4748. [PMID: 28684781 PMCID: PMC5500537 DOI: 10.1038/s41598-017-05044-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 05/24/2017] [Indexed: 02/07/2023] Open
Abstract
Based on the severity of liver fibrosis, low or high-risk profile of developing end-stage liver disease was present in nonalcoholic fatty liver disease (NAFLD). However, the mechanisms inducing transition from mild to advanced NAFLD are still elusive. We performed a system-level study on fibrosing-NAFLD by weighted gene co-expression network analysis (WGCNA) to identify significant modules in the network, and followed by functional and pathway enrichment analyses. Moreover, hub genes in the module were analyzed by network feature selection. As a result, fourteen distinct gene modules were identified, and seven modules showed significant associations with the status of NAFLD. Module preservation analysis confirmed that these modules can also be found in diverse independent datasets. After network feature analysis, the magenta module demonstrated a remarkably correlation with NAFLD fibrosis. The top hub genes with high connectivity or gene significance in the module were ultimately determined, including LUM, THBS2, FBN1 and EFEMP1. These genes were further verified in clinical samples. Finally, the potential regulators of magenta module were characterized. These findings highlighted a module and affiliated genes as playing important roles in the regulation of fibrosis in NAFLD, which may point to potential targets for therapeutic interventions.
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