Obesity and Weight Gain Are Associated With Progression of Fibrosis in Patients With Nonalcoholic Fatty Liver Disease

Kim, Yejin; Chang, Yoosoo; Cho, Yong Kyun; Ahn, Joong Kyong; Shin, Hocheol; Ryu, Seungho

doi:10.1016/j.cgh.2018.07.006

Cited by 59 publications

(57 citation statements)

References 34 publications

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“…First, although PS matching and IPTW analyses can compensate for the lack of randomization and reduce bias and measured confounders [12], residual bias and unmeasured confounders may still exist. Furthermore, the retrospective nature of our study limits the assessment of variables including dietary intake, daily physical activity or exercise, and weight change, all of which may affect outcomes in patients with chronic liver disease [3,6,27]. It, therefore, follows from this point that a RCT is optimal to determine an effect of intervention on outcomes [12].…”

Section: Discussionmentioning

confidence: 99%

Late Evening Snack with Branched-Chain Amino Acids Supplementation Improves Survival in Patients with Cirrhosis

Hanai

Shiraki

Imai

et al. 2020

JCM

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The clinical efficacy of a late evening snack (LES) is well documented in patients with cirrhosis, but its effect on survival remains unclear. This cohort study aimed to compare the overall survival between LES-treated patients and untreated patients. We conducted a retrospective cohort study to determine the effect of LES, which is defined as an oral intake of a branched-chain amino acids (BCAA)-enriched nutrient before bedtime, on survival in 523 patients with cirrhosis seen at a tertiary referral center in Japan from March 2004 to April 2019. The association between LES and all-cause mortality was evaluated using propensity score matching and inverse probability of treatment weighting analyses. The median age of the 523 participants was 66 years; 286 (55%) patients were men and 87 (17%) received LES therapy. Of the 231 propensity-matched patients, 20 (26%) LES-treated patients and 72 (47%) untreated patients died during a median follow-up of 2.0 years (interquartile range, 0.5–4.8). Propensity score matching analysis showed that the overall survival was significantly higher in LES-treated patients than in untreated patients (hazard ratio [HR], 0.57; 95% confidence interval [CI], 0.34–0.93). The survival benefit of LES therapy was most prominent in patients with Child–Pugh C cirrhosis (HR, 0.40; 95% CI, 0.20–0.81). Inverse probability of treatment weighting analysis also revealed that LES significantly improved the prognosis of patients with cirrhosis (HR, 0.57; 95% CI, 0.33–0.99). In this retrospective study of patients with cirrhosis, we found that nocturnal BCAA supplementation was associated with a significant reduction in the risk of death in patients with liver cirrhosis.

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Section: Discussionmentioning

confidence: 99%

Late Evening Snack with Branched-Chain Amino Acids Supplementation Improves Survival in Patients with Cirrhosis

Hanai

Shiraki

Imai

et al. 2020

JCM

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“…Several mechanisms might explain the shared effects of exercise and adiposity on liver disease progression and mortality. Obesity is marked by disproportionately increased visceral adipose tissue (VAT) volume, which promotes fibrosis progression, 47,48 while exercise preferentially reduces VAT, even when weight loss is not achieved. 36,49,50 Further, exercise interventions can attenuate liver fat and inflammation, 14,15,19,36,44 normalize pro-inflammatory biomarkers 50,51 and modulate bile acids, 52 which may impact the natural history of liver disease.…”

Section: Discussionmentioning

confidence: 99%

Physical activity compared to adiposity and risk of liver-related mortality: Results from two prospective, nationwide cohorts

Simon

Kim

Luo

et al. 2020

Journal of Hepatology

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“…The risk of liver fibrosis (Fibrosis‐4 ≥ 2.67) in patients with NAFLD was lower in men than women after adjusting for other metabolic variables . The risk of fibrosis progression assessed by the aspartate aminotransferase to platelet ratio index in a NAFLD population was associated with obesity and weight gain but not sex . These studies did not consider menopausal status or an age‐specific sex difference, which may have confounded the results (Table ).…”

Section: Sex Differences In Clinical Nafldmentioning

confidence: 99%

Sex Differences in Nonalcoholic Fatty Liver Disease: State of the Art and Identification of Research Gaps

et al. 2019

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Despite tremendous research advancements in nonalcoholic fatty liver disease (NAFLD), our understanding of sex differences in NAFLD remains insufficient. This review summarizes the current knowledge on sex differences in NAFLD, identifies gaps, and discusses important considerations for future research. The prevalence and severity of NAFLD are higher in men than in women during the reproductive age. However, after menopause, NAFLD occurs at a higher rate in women, suggesting that estrogen is protective. Sex differences also exist for the major risk factors of NAFLD. In general, animal models of NAFLD recapitulate the sex differences observed in patients, with more severe steatosis and steatohepatitis, more proinflammatory/profibrotic cytokines, and a higher incidence of hepatic tumors in male than female subjects. Based on computer modeling, female and male livers are metabolically distinct with unique regulators modulating sex-specific metabolic outcomes. Analysis of the literature reveals that most published clinical and epidemiological studies fail to examine sex differences appropriately. Considering the paucity of data on sex differences and the knowledge that regulators of pathways relevant to current therapeutic targets for NAFLD differ by sex, clinical trials should be designed to test drug efficacy and safety according to sex, age, reproductive stage (i.e., menopause), and synthetic hormone use. Conclusion: Sex differences do exist in the prevalence, risk factors, fibrosis, and clinical outcomes of NAFLD, suggesting that, while not yet incorporated, sex will probably be considered in future practice guidelines; adequate consideration of sex differences, sex hormones/menopausal status, age, and other reproductive information in clinical investigation and gene association studies of NAFLD are needed to fill current gaps and implement precision medicine for patients with NAFLD.

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Obesity and Weight Gain Are Associated With Progression of Fibrosis in Patients With Nonalcoholic Fatty Liver Disease

Cited by 59 publications

References 34 publications

Late Evening Snack with Branched-Chain Amino Acids Supplementation Improves Survival in Patients with Cirrhosis

Late Evening Snack with Branched-Chain Amino Acids Supplementation Improves Survival in Patients with Cirrhosis

Physical activity compared to adiposity and risk of liver-related mortality: Results from two prospective, nationwide cohorts

Sex Differences in Nonalcoholic Fatty Liver Disease: State of the Art and Identification of Research Gaps

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