Asia–Pacific Working Party on Non‐alcoholic Fatty Liver Disease guidelines 2017—Part 1: Definition, risk factors and assessment

Background and Aim The recommendation in regard to screening for non‐alcoholic fatty liver disease (NAFLD) among type 2 diabetes mellitus (T2DM) patients differs in major guidelines. The aim of this paper was to study the prevalence of NALFD and advanced fibrosis among T2DM patients. Methods This is a cross‐sectional study of consecutive adult T2DM patients attending the Diabetes Clinic of a university hospital. Significant hepatic steatosis and advanced fibrosis was diagnosed based on transient elastography if the controlled attenuation parameter was ≥ 263 dB/m, and the liver stiffness measurement was ≥ 9.6 kPa using the M probe or ≥ 9.3 kPa using the XL probe, respectively. Patients with liver stiffness measurement ≥ 8 kPa were referred to the Gastroenterology and Hepatology Clinic for further assessment, including liver biopsy. Results The data of 557 patients were analyzed (mean age 61.4 ± 10.8 years, male 40.6%). The prevalence of NAFLD and advanced fibrosis based on transient elastography was 72.4% and 21.0%, respectively. On multivariate analysis, independent factors associated with NAFLD were central obesity (OR 4.856, 95% confidence interval [CI] 2.749–8.577, P = 0.006), serum triglyceride (OR 1.585, 95% CI 1.056–2.381, P = 0.026), and alanine aminotransferase levels (OR 1.047, 95% CI 1.025–1.070, P < 0.001) while advanced fibrosis was associated with serum high‐density lipoprotein cholesterol (OR 0.355, 95% CI 0.126–0.997, P = 0.049), alanine aminotransferase (OR 1.023, 95% CI 1.009–1.037, P = 0.001), γ‐glutamyltransferase (OR 1.005, 95% CI 1.001–1.008, P = 0.017), and platelet levels (OR 0.995, 95% CI 0.992–0.999, P = 0.010). Seventy‐one patients underwent liver biopsy. The majority had non‐alcoholic steatohepatitis (83.1%) and ≥ F1 fibrosis (87.3%) while advanced fibrosis was seen in 36.6%. Conclusion The prevalence of NAFLD and advanced fibrosis based on transient elastography is high among T2DM patients.

Section: Discussionmentioning

confidence: 87%

Screening for non‐alcoholic fatty liver disease in patients with type 2 diabetes mellitus using transient elastography

Lai

Yusoff

Vethakkan

et al. 2019

“…Non‐alcoholic fatty liver disease comprises a wide spectrum liver disease with variable prognoses, most of which have a benign nature independent of liver‐related morbidity or mortality . However, in a small number of patients with NAFLD, IR, persistent chronic inflammation, and oxidative stress lead to progressive histologic progression, resulting in advanced fibrosis and increasing liver‐related morbidity and mortality . In particular, NAFLD patients with advanced fibrosis are three times more likely to experience liver‐related mortality than the general population and correlates with cardiovascular‐related mortality …”

Section: Discussionmentioning

confidence: 99%

“…Preferentially, 42 993 subjects were excluded based on the following criteria: (i) < 20 years old ( n = 3673); (ii) positive serologic results for hepatitis B ( n = 642) or C ( n = 24); (iii) excessive alcohol intake (men > 140 g/week; women > 70 g/week) ( n = 976); (iv) inadequate data ( n = 24 476); and (v) no fatty liver found on abdominal US ( n = 12 932) . A total of 10 711 NAFLD patients were included.…”

Section: Methodsmentioning

confidence: 99%

Association of low skeletal muscle mass with advanced liver fibrosis in patients with non‐alcoholic fatty liver disease

Kang

Park

Lee

et al. 2019

Background and Aim Although low skeletal muscle mass (LSMM) is known to increase the risk of non‐alcoholic fatty liver disease (NAFLD), limited reports have described the relationship between LSMM and advanced fibrosis. Here, we investigated the association between LSMM and advanced liver fibrosis in NAFLD patients. Methods Fatty liver was diagnosed using ultrasound, and appendicular skeletal muscle mass (ASM) was measured using bioelectrical impedance analysis. LSMM was defined in two ways: ASM/body weight percentage (LSMM‐BW) and ASM/body mass index. Liver fibrosis stage was assessed by two models, the NAFLD fibrosis score and the Fibrosis‐4 index, which determined low and high cutoff values (COVs). Results Of 10 711 NAFLD patients, 615 were diagnosed with LSMM‐BW. LSMM patients were older (47.6 vs 52.5 years, P = 0.001) and had higher body mass index values (23.6 vs 29.1 kg/m2, P < 0.001) and waist circumferences (80.1 vs 93.3 cm, P < 0.001) than non‐LSMM patients. LSMM was an independent risk factor for advanced fibrosis assessed by a low COV for the Fibrosis‐4 index regardless of its classification (adjusted for metabolic and lipid profiles and sex, odds ratio [OR], 1.27–2.01; all P < 0.05). LSMM was an independent risk factor for advanced fibrosis assessed by both COVs of NAFLD fibrosis score (adjusted for obesity, hypertension, lipid profile, and sex; OR, 1.64–2.01, P < 0.01 in the low COV group; OR, 2.68–3.12, P = 0.002 in the high COV group). Conclusions Low skeletal muscle mass is associated with advanced fibrosis in NAFLD patients independent of metabolic risk factors.

“…4 The presence of fatty liver was based on (i) radiological features (abdominal ultrasonography, computed tomography, or magnetic resonance imaging) within the last 6 months, (ii) histological steatosis involving ≥ 5% of hepatocytes within the last 12 months, and/or (iii) unexplained elevation of alanine aminotransferase (ALT) or aspartate aminotransferase (AST) with a controlled attenuation parameter (CAP) value ≥ 248 dB/m within the last 6 months. The study conformed to the ethical guidelines of the 1975 Declaration of Helsinki, and ethical approval was obtained from all participating centers.…”

Section: Methodsmentioning

confidence: 99%

Suboptimal treatment of dyslipidemia in patients with nonalcoholic fatty liver disease

Khoo

Wong

Goh

et al. 2019

Self Cite

Background and Aim Nonalcoholic fatty liver disease (NAFLD) patients often have dyslipidemia, and optimal treatment of dyslipidemia lowers the risk of cardiovascular disease and mortality. Our aim was to study the prescription of statin and low‐density lipoprotein cholesterol treatment targets in NAFLD patients. Methods Consecutive NAFLD patients attending five clinics in Asia were included in this study. The 10‐year cardiovascular disease risk was calculated based on the Framingham Heart Study, and patients were categorized as moderate, high, or very high risk for cardiovascular disease on the basis of the American Association of Clinical Endocrinologist 2017 Guidelines. The low‐density lipoprotein cholesterol treatment goal for each of the risk groups was 2.6, 2.6, and 1.8 mmol/L, respectively. Results The data for 428 patients were analyzed (mean age 54.4 ± 11.1 years, 52.1% male). Dyslipidemia was seen in 60.5% (259/428), but only 43.2% (185/428) were on a statin. The percentage of patients who were at moderate, high, and very high risk for cardiovascular disease was 36.7% (157/428), 27.3% (117/428), and 36.0% (154/428), respectively. Among patients who were on a statin, 58.9% (109/185) did not achieve the treatment target. Among patients who were not on a statin, 74.1% (180/243) should be receiving statin therapy. The percentage of patients who were not treated to target or who should be on statin was highest among patients at very high risk for cardiovascular disease at 79.6% (78/98) or 94.6% (53/56), respectively. Conclusion This study highlights the suboptimal treatment of dyslipidemia and calls for action to improve the treatment of dyslipidemia in NAFLD patients.