AGA Clinical Practice Update: Diagnosis and Management of Nonalcoholic Fatty Liver Disease in Lean Individuals: Expert Review

Long, Michelle T.; Noureddin, Mazen; Lim, Joseph K.

doi:10.1053/j.gastro.2022.06.023

Cited by 147 publications

(149 citation statements)

References 89 publications

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“…After initial risk stratification (i.e., FIB-4, LSM, and/or patented biomarkers), people with diabetes at indeterminate or high risk of fibrosis should be referred, based on practice setting, to a gastroenterologist or hepatologist for further workup within the framework of a multidisciplinary team (64,105,106).…”

Section: )mentioning

confidence: 99%

4. Comprehensive Medical Evaluation and Assessment of Comorbidities:Standards of Care in Diabetes—2023

ElSayed¹,

Aroda²,

Bannuru³

et al. 2022

Diabetes Care

116

131

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The American Diabetes Association (ADA) “Standards of Care in Diabetes” includes the ADA’s current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA’s clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

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Section: )mentioning

confidence: 99%

4. Comprehensive Medical Evaluation and Assessment of Comorbidities:Standards of Care in Diabetes—2023

ElSayed¹,

Aroda²,

Bannuru³

et al. 2022

Diabetes Care

116

131

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“…While the current ndings are limited by cross-sectional data and may be a byproduct of cirrhosis, it may elute to the possibility of liver disease progression independent of weight and metabolic dysfunction in Asian NAFLD 35 . The American Gastroenterology Association (AGA) clinical practice update recognizes the clinical subtype of lean NAFLD particularly amongst Asians 36 and a recent biopsy proven study of 1339 individuals found that lean individuals were similarly at risk of liver related events and mortality compared to their overweight counterparts 35 . Additionally, a recent study by Luukkonen et al 37 found two subtypes of NAFLD where the metabolic subtype of NAFLD was substantially more affected by insulin resistance compared to the genetic subtype of NAFLD.…”

Section: Discussionmentioning

confidence: 99%

Factors Associated with Risk of NAFLD and Progression in Multiethnic Asians. A Latent Class and Machine Learning Analysis

Nah

Kaewdech

et al. 2022

Preprint

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Introduction Non-alcoholic fatty liver disease (NAFLD) is the commonest liver condition globally. However, Asians with NAFLD are significantly different from the west. Despite the significant prevalence of the disease, studies on Asians particularly from southeast Asians are lacking. Herein, we examine the prevalence, risk factors and different classes of NAFLD based on a multicenter cohort study from five centers in Asia. Methods A multicenter study involving the use of vibration-controlled transient elastography (VCTE) for the assessment of NAFLD based on a cutoff of ≥ 288 dB/m and liver fibrosis was examined through liver stiffness measures (LSM). Risk factors were examined through risk ratios (RR) from a generalized linear model and gradient boosting machines (GBM) machine learning model. A latent class analysis (LCA) was additionally conducted to explore subtypes of NAFLD in Asia. Results Of the 1,686 individuals included in the analysis, a total of 822 individuals were identified to have NAFLD. Factors that were associated with an increased risk of NAFLD included male gender, elevated serum lipid levels and diagnosis of hypertension or diabetes mellitus with similar findings from GBM. LCA identified two subtypes of NAFLD. Class 1 LCA had lower rates of metabolic dysfunction and were more likely lean relative to Class 2 LCA. However, both classes were at similar risk of clinically significant fibrosis and advance fibrosis. The risk of cirrhosis was higher in Class 1 LCA. Discussion The current analysis describes the prevalence and risk factors of NAFLD in a multiethnic Asian cohort with conventional regression and GBM analysis. Subclasses of NAFLD identified from LCA found that patients with lower rates of metabolic dysfunction had similar if not increased rates of fibrosis.

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“…Recent data indicate that screening and risk-stratification pathways for NAFLD are cost-effective among patients with T2DM [ 47 ]. Considering the respective data, the American Gastroenterological Association (AGA) proposes screening for NAFLD and risk stratification for advanced fibrosis and also in lean patients with T2DM [ 48 ]. NASH represents the next stage in the natural evolution of NAFLD, involving up to 20% of these patients [ 49 ].…”

Section: Diagnosismentioning

confidence: 99%

Nonalcoholic Fatty Liver Disease and Its Complex Relation with Type 2 Diabetes Mellitus—From Prevalence to Diagnostic Approach and Treatment Strategies

Diaconu

Guja

2022

JCM

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Prevalence of Nonalcoholic Fatty Liver Disease (NAFLD) and Type 2 Diabetes Mellitus (T2DM) are increasing rapidly worldwide, reaching epidemic proportions. Their association, based on common metabolic risk factors (obesity, insulin resistance (IR), unhealthy lifestyle), brings an additional risk of both hepatic and cardiovascular (CV) adverse clinical outcomes. The terminology of “NAFLD” is stigmatizing to some but not all patients, and a more practical one should be announced soon. Medical strategies can address both diseases simultaneously, as they have crossing pathophysiological mechanisms, mainly IR. Strategies vary from lifestyle intervention and pharmacological options, as more molecules designated for T2DM treatment may be helpful in NAFLD, to surgical procedures. This review focuses on the coexistence of NAFLD and T2DM, pointing out the utility of the appropriate terminology, its prevalence, and mortality rates among the diabetic population. Briefly, we have discussed the main pathophysiological mechanisms and the risk stratification algorithm for the development of NAFLD and nonalcoholic steatohepatitis (NASH) as well as the tools for evaluation of fibrosis. Finally, we have focused on the current therapeutic options for the treatment of NAFLD associated with T2DM.

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AGA Clinical Practice Update: Diagnosis and Management of Nonalcoholic Fatty Liver Disease in Lean Individuals: Expert Review

Cited by 147 publications

References 89 publications

4. Comprehensive Medical Evaluation and Assessment of Comorbidities:Standards of Care in Diabetes—2023

4. Comprehensive Medical Evaluation and Assessment of Comorbidities:Standards of Care in Diabetes—2023

Factors Associated with Risk of NAFLD and Progression in Multiethnic Asians. A Latent Class and Machine Learning Analysis

Nonalcoholic Fatty Liver Disease and Its Complex Relation with Type 2 Diabetes Mellitus—From Prevalence to Diagnostic Approach and Treatment Strategies

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