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Virović Jukić L, Grgurević I, Mikolašević I, Filipec Kanižaj T, Milić S, Mrzljak A, Premužić M, Hrstić I, Knežević-Štromar I, Ljubičić N, Ostojić R, Stojsavljević Shapeski S, Amerl-Šakić V, Marković NB, Rađa M, Soldo D, Sobočan N, Lalovac M, Puljiz Ž, Podrug K, Ladić D. CROATIAN GUIDELINES FOR THE DIAGNOSIS AND TREATMENT OF NONALCOHOLIC FATTY LIVER DISEASE. Acta Clin Croat 2021; 60:36-52. [PMID: 35528151 PMCID: PMC9036273 DOI: 10.20471/acc.2021.60.s1.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Nonalcoholic fatty liver disease (NAFLD) is a term describing excessive accumulation of fat in hepatocytes, and is associated with metabolic syndrome and insulin resistance. NAFLD prevalence is on increase and goes in parallel with the increasing prevalence of metabolic syndrome and its components. That is why Croatian guidelines have been developed, which cover the screening protocol for patients with NAFLD risk factors, and the recommended diagnostic work-up and treatment of NAFLD patients. NAFLD screening should be done in patients with type 2 diabetes mellitus, or persons with two or more risk factors as part of metabolic screening, and is carried out by noninvasive laboratory and imaging methods used to detect fibrosis. Patient work-up should exclude the existence of other causes of liver injury and determine the stage of fibrosis as the most important factor in disease prognosis. Patients with initial stages of fibrosis continue to be monitored at the primary healthcare level with the management of metabolic risk factors, dietary measures, and increased physical activity. Patients with advanced fibrosis should be referred to a gastroenterologist/hepatologist for further treatment, monitoring, and detection and management of complications.
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Affiliation(s)
- Lucija Virović Jukić
- School of Medicine, University of Zagreb, Zagreb, Croatia
- Sestre milosrdnice University Hospital Center, Zagreb, Croatia
- Croatian Society of Gastroenterology, Zagreb, Croatia
| | - Ivica Grgurević
- School of Medicine, University of Zagreb, Zagreb, Croatia
- Croatian Society of Gastroenterology, Zagreb, Croatia
- Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
- Dubrava University Hospital, Zagreb, Croatia
| | - Ivana Mikolašević
- Croatian Society of Gastroenterology, Zagreb, Croatia
- School of Medicine, University of Rijeka, Rijeka, Croatia
- Rijeka University Hospital Center, Rijeka, Croatia
| | - Tajana Filipec Kanižaj
- School of Medicine, University of Zagreb, Zagreb, Croatia
- Croatian Society of Gastroenterology, Zagreb, Croatia
- Merkur University Hospital, Zagreb, Croatia
| | - Sandra Milić
- Croatian Society of Gastroenterology, Zagreb, Croatia
- School of Medicine, University of Rijeka, Rijeka, Croatia
- Rijeka University Hospital Center, Rijeka, Croatia
| | - Anna Mrzljak
- School of Medicine, University of Zagreb, Zagreb, Croatia
- Croatian Society of Gastroenterology, Zagreb, Croatia
- Zagreb University Hospital Center, Zagreb, Croatia
| | - Marina Premužić
- Croatian Society of Gastroenterology, Zagreb, Croatia
- Zagreb University Hospital Center, Zagreb, Croatia
| | - Irena Hrstić
- Croatian Society of Gastroenterology, Zagreb, Croatia
- School of Medicine, University of Rijeka, Rijeka, Croatia
- Pula General Hospital, Pula, Croatia
| | - Ivana Knežević-Štromar
- Croatian Society of Gastroenterology, Zagreb, Croatia
- Zagreb University Hospital Center, Zagreb, Croatia
| | - Neven Ljubičić
- School of Medicine, University of Zagreb, Zagreb, Croatia
- Sestre milosrdnice University Hospital Center, Zagreb, Croatia
- Croatian Society of Gastroenterology, Zagreb, Croatia
- School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Rajko Ostojić
- School of Medicine, University of Zagreb, Zagreb, Croatia
- Croatian Society of Gastroenterology, Zagreb, Croatia
- Zagreb University Hospital Center, Zagreb, Croatia
| | - Sanja Stojsavljević Shapeski
- Sestre milosrdnice University Hospital Center, Zagreb, Croatia
- Croatian Society of Gastroenterology, Zagreb, Croatia
| | - Vjekoslava Amerl-Šakić
- Vjekoslava Amerl-Šakić Family Medicine Practice, Zagreb, Croatia
- Coordination of the Croatian Family Medicine for Prevention Programs, Zagreb, Croatia
| | - Nina Bašić Marković
- School of Medicine, University of Rijeka, Rijeka, Croatia
- Nina Bašić Marković Family Medicine Practice, Rijeka, Croatia
- Society of Teachers of General-Family Medicine, Rijeka, Croatia
| | - Marko Rađa
- Healthcare Center of the Split-Dalmatia County, Split, Croatia
- Croatian Family Medicine Society, Split, Croatia
| | - Dragan Soldo
- School of Medicine, University of Zagreb, Zagreb, Croatia
- Zagreb-Center Healthcare Center, Zagreb, Croatia
- Andrija Štampar School of Public Health, Zagreb, Croatia
- Croatian Society of Family Physicians, Croatian Medical Association, Zagreb, Croatia
| | - Nikola Sobočan
- School of Medicine, University of Zagreb, Zagreb, Croatia
- Croatian Society of Gastroenterology, Zagreb, Croatia
- Merkur University Hospital, Zagreb, Croatia
| | - Miloš Lalovac
- Croatian Society of Gastroenterology, Zagreb, Croatia
- Merkur University Hospital, Zagreb, Croatia
| | - Željko Puljiz
- Croatian Society of Gastroenterology, Zagreb, Croatia
- School of Medicine, University of Split, Split, Croatia
- Split University Hospital Center, Split, Croatia
| | - Kristian Podrug
- Croatian Society of Gastroenterology, Zagreb, Croatia
- Split University Hospital Center, Split, Croatia
| | - Dinko Ladić
- Croatian Society of Gastroenterology, Zagreb, Croatia
- Osijek University Hospital Center, Osijek, Croatia
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Vranešić Bender D, Nutrizio M, Jošić M, Ljubas Kelečić D, Karas I, Premužić M, Domislović V, Rotim C, Krznarić Ž. Nutritional Status and Nutrition Quality in Patients with Non-Alcoholic Fatty Liver Disease. Acta Clin Croat 2017; 56:625-634. [PMID: 29590715 DOI: 10.20471/acc.2017.56.04.07] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) is becoming a major health burden with increasing prevalence worldwide due to its close association with the epidemic of obesity. Currently there is no standardized pharmacological treatment, and the only proven effective therapeutic strategy is lifestyle modification, therefore it is important to determine the potential dietary targets for the prevention and treatment of NAFLD. We assessed nutritional status in 30 patients diagnosed with NAFLD using anthropometric parameters, hand grip strength, and lifestyle and dietetic parameters (physical activity, NRS2002 form and three-day food diary). The mean body mass index was 29.62±4.61 kg/m2, yielding 86.67% of obese or overweight patients. Physical activity results indicat-ed poorly active subjects. Excessive energy intake was recorded in 27.78% of patients. The mean in-take of macronutrients was as follows: 15.5% of proteins, 42.3% of carbohydrates and 42.2% of fat, with -deficient micronutrient intake of calcium, magnesium, iron, zinc, and vitamins A, B1 and B2. The -results showed that the quality of nutrition in study subjects was not accordant to current rec-ommendations and that they consumed a high proportion of fat, especially saturated fatty acids, along with low micronutrient intake. The results obtained might point to the importance of unbalanced diet as a contributing factor in NAFLD development.
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Affiliation(s)
| | | | | | | | - Irena Karas
- Faculty of Food Technology and Biotechnology, Zagreb, Croatia
| | - Marina Premužić
- Zagreb University Hospital Center, Division of Gastroenterology, Zagreb, Croatia
| | - Viktor Domislović
- Zagreb University Hospital Center, Division of Gastroenterology, Zagreb, Croatia
| | - Cecilija Rotim
- Dr Andrija Štampar Teaching Institute of Public Health, Zagreb, Croatia
| | - Željko Krznarić
- Faculty of Food Technology and Biotechnology, Zagreb, Croatia.,Zagreb University Hospital Center, Division of Gastroenterology, Zagreb, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia
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Majerović M, Jelaković M, Premužić M, Štromar IK, Radić D, Mance M, Pleština S, Ostojić R, Rustemović N, Krznarić Z. Hepatocellular Carcinoma Surveillance-Experience from Croatian Referral Centre for Chronic Liver Diseases. J Gastrointest Cancer 2017; 50:48-53. [PMID: 29127665 DOI: 10.1007/s12029-017-0011-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE For patients at high-risk of developing hepatocellular carcinoma (HCC), biannual ultrasound surveillance has long been recommended, in order to detect the tumor in the early, potentially curative stages. However, globally reported HCC surveillance rates vary greatly, ranging from as low as 1.7 to as high as 80%. Our aim was to assess the utilization of surveillance with biannual ultrasound in high-risk Croatian patients and to identify the factors that impact the implementation of the recommended protocol. METHODS This retrospective study included 145 newly diagnosed HCC patients in the period from January 2010 to September 2015. We identified low-risk and high-risk patients. The latter were further subdivided into the regular biannual ultrasound surveillance group and the non-surveillance group. The groups were compared according to demographic characteristics and BCLC stage at the time of HCC diagnosis. RESULTS Among 145 patients, 80 patients were classified as high-risk according to EASL criteria. During the relevant period, 28.7% underwent regular surveillance, while 71.25% did not. Younger patients were more likely to undergo surveillance (OR 0.935 CI 0.874-0.999; p = 0.05). The patients who underwent regular surveillance had a higher chance of being diagnosed at a curative stage (BCLC 0 or A) (OR 3.701 CI 1.279-10.710; p < 0.05).Gender was not a predictor of participation in the regular surveillance protocol. Among the high-risk patients who did not undergo regular surveillance, 56.1% were not aware of the chronic liver disease prior to the HCC diagnosis. CONCLUSION HCC surveillance is still underutilized in high-risk Croatian patients despite its obvious benefits possibly due to the untimely diagnosis of the chronic liver disease.
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Affiliation(s)
- Matea Majerović
- Department of Gastroenterology and Hepatology, University Hospital Centre Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia
| | - Mislav Jelaković
- Department of Gastroenterology and Hepatology, University Hospital Centre Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia.
| | - Marina Premužić
- Department of Gastroenterology and Hepatology, University Hospital Centre Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia
| | - Ivana Knežević Štromar
- Department of Gastroenterology and Hepatology, University Hospital Centre Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia
| | - Davor Radić
- Department of Gastroenterology and Hepatology, University Hospital Centre Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia
| | - Marko Mance
- Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Stjepko Pleština
- Department of Oncology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Rajko Ostojić
- Department of Gastroenterology and Hepatology, University Hospital Centre Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia
| | - Nadan Rustemović
- Department of Gastroenterology and Hepatology, University Hospital Centre Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia
| | - Zeljko Krznarić
- Department of Gastroenterology and Hepatology, University Hospital Centre Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia
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Majerović M, Boban A, Premužić M, Radić D, Knežević-Štromar I, Ladić A, Krznarić Ž, Rustemović N, Ostojić R. [ABNORMALITIES OF HEMOSTASIS IN PATIENTS WITH LIVER CIRRHOSIS]. Lijec Vjesn 2016; 138:272-281. [PMID: 30148556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Until the beginning of the 90ies, it was believed that patients with liver cirrhosis were auto-anticoagulated and thus protected from thromboembolic events. However, new discoveries have broken the longstanding paradigm. In deranged hepatic function there is a reduced synthesis of procoagulants and endogenous anticoagulants, however, extrahepatally synthesized hemostatic and fibrinolytic factors are disproportionately affected. In stable disease hemostatic system is ”rebalanced’’ but fragile, therefore, even a minimal stress can promote bleeding or thrombosis. Also, there are many concomitant factors, such as hemodynamic changes, other organ affection, namely kidney, and predisposition to infection, that shift the balance towards either bleeding or thrombosis. Conventional laboratory tests are not sufficient for evaluation of the bleeding risk, prothrombotic risk factors are not clearly identified, and safety profile of antithrombotic drugs is not precisely evaluated since cirrhotic patients are mainly excluded from big clinical trials. For all that is said, the diagnostic and therapeutic approach in this context is complex and requires teamwork of a hepatologist, hematologist and in a phase of operative treatment, the anesthesiologist. In this review article, we will discuss mechanisms of hemostatic and fibrinolytic abnormalities of liver cirrhosis, the incidence of thromboembolic events as well as prophylactic and therapeutic options in the setting of conservative treatment.
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Ljubić H, Kalauz M, Telarović S, Ferenci P, Ostojić R, Noli MC, Lepori MB, Hrstić I, Vuković J, Premužić M, Radić D, Ravić KG, Sertić J, Merkler A, Barišić AA, Loudianos G, Vucelić B. ATP7B Gene Mutations in Croatian Patients with Wilson Disease. Genet Test Mol Biomarkers 2016; 20:112-7. [DOI: 10.1089/gtmb.2015.0213] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Hana Ljubić
- Department of Laboratory Diagnostics, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Mirjana Kalauz
- Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Srđana Telarović
- Department of Neurology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Peter Ferenci
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Rajko Ostojić
- Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Maria Cristina Noli
- Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
| | - Maria Barbara Lepori
- Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
| | - Irena Hrstić
- Department of Internal Medicine, General Hospital Pula, Pula, Croatia
| | - Jurica Vuković
- Department of Pediatrics, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Marina Premužić
- Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Davor Radić
- Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Katja Grubelić Ravić
- Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Jadranka Sertić
- Department of Laboratory Diagnostics, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Ana Merkler
- Department of Laboratory Diagnostics, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Ana Acman Barišić
- Department of Laboratory Diagnostics, University Hospital Centre Zagreb, Zagreb, Croatia
| | | | - Boris Vucelić
- Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
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