Comprehensive Review and Updates on Holistic Approach Towards Non-Alcoholic Fatty Liver Disease Management with Cardiovascular Disease

Chew, Nicholas; Ng, Cheng Han; Muthiah, Mark; Sanyal, Arun J.

doi:10.1007/s11883-022-01027-5

Cited by 25 publications

(23 citation statements)

References 181 publications

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“… 3 Visceral adiposity has epidemiological links to major preventable causes of death and disability, including type 2 diabetes, cardiovascular diseases, stroke, nonalcoholic fatty liver disease, malignancy, and many other metabolic diseases. 4 , 5 , 6 …”

Section: Introductionmentioning

confidence: 99%

The placebo response rate and nocebo events in obesity pharmacological trials. A systematic review and meta-analysis

Chin¹,

Ng²,

Chew³

et al. 2022

eClinicalMedicine

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Section: Introductionmentioning

confidence: 99%

The placebo response rate and nocebo events in obesity pharmacological trials. A systematic review and meta-analysis

Chin¹,

Ng²,

Chew³

et al. 2022

eClinicalMedicine

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“…It is, however, important to note that despite the presence of a bidirectional relationship, current guidelines by the American Heart Association (AHA) ( 17 ) and European Society of Hypertension (ESH) ( 31 ) have yet to recognize NAFLD as a potential cause of HTN and the awareness of NAFLD remains low amongst cardiologists ( 41 ). While lifestyle modifications serve as a forefront in the care of NAFLD ( 8 , 42 ) and HTN, these interventions are often unsuitable ( 43 , 44 ). Instead, ACE inhibitors may be considered for use in individuals with NAFLD due to the multifactorial benefits they present where aside from regulation of blood pressure ( 45 ), ACE inhibitors have been found to reduce decompensation ( 46 ), hepatic fibrosis ( 47 ), and steatosis ( 48 ) in NAFLD and may also provide protection against CKD ( 49 ).…”

Section: Discussionmentioning

confidence: 99%

“…NAFLD is the leading cause of cirrhosis, liver disorders, and liver-related mortality (4)(5)(6). The increased fat deposition in hepatocytes results from a myriad of factors including insulin resistance, lipotoxicity, and changes in gut microbiota can increase hepatic and extrahepatic complications (7)(8)(9). Several epidemiological studies have shown that NAFLD can lead to an increment in all-cause mortality and is significantly associated with the development of hypertension (HTN), cardiovascular diseases (CVDs), hepatocellular carcinoma, diabetes mellitus, and renal and lung diseases (6,(10)(11)(12)(13)(14)(15).…”

Section: Introductionmentioning

confidence: 99%

Hypertension is prevalent in non-alcoholic fatty liver disease and increases all-cause and cardiovascular mortality

Wong

Chew

et al. 2022

Front. Cardiovasc. Med.

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Background and aimsHypertension (HTN) is a common comorbidity in non-alcoholic fatty liver disease (NAFLD) affecting up to 40% of individuals. However, the impact of HTN and its control on outcomes in NAFLD remains unclear. Therefore, we aimed to examine the impact of HTN on survival outcomes in a longitudinal cohort of NAFLD patients.MethodsThe analysis consisted of adults in the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018 with data on socio-demographic characteristics and comorbidities. NAFLD was diagnosed with fatty liver index (FLI) and United States-FLI at a cut-off of 60 and 30, respectively in the substantial absence of alcohol use. A multivariate regression analysis was conducted to adjust for confounders.ResultsA total of 45,302 adults were included, and 27.83% were identified to have NAFLD. Overall, 45.65 and 35.12% of patients with NAFLD had HTN and uncontrolled HTN, respectively. A multivariate analysis with confounders demonstrated that hypertensive NAFLD had a significantly increased risk of all-cause mortality (HR: 1.39, CI: 1.14–1.68, p < 0.01) and cardiovascular disease (CVD) mortality (HR: 1.85, CI: 1.06–3.21, p = 0.03). Untreated HTN remained to have a significantly increased risk in all-cause (HR: 1.59, CI: 1.28–1.96, p < 0.01) and CVD mortality (HR: 2.36, CI: 1.36–4.10, p < 0.01) while treated HTN had a non-significant increased risk of CVD mortality (HR: 1.51, CI: 0.87–2.63, p = 0.14) and a lower magnitude of increase in the risk of all-cause mortality (HR: 1.26, CI: 1.03–1.55, p = 0.03).ConclusionDespite the significant burden of HTN in NAFLD, up to a fifth of patients have adequate control, and the lack thereof significantly increases the mortality risk. With the significant association of HTN in NAFLD, patients with NAFLD should be managed with a multidisciplinary team to improve longitudinal outcomes.

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“…Interestingly, poor weight perception tends to affect individuals who are overweight compared to obese, as seen whereby the population of individuals with poor weight perception were associated with lower BMI and have lower rates of obesity. With the increasing prevalence of obesity (30), people of larger body types become an increasingly common sight, and this results in visual normalization of larger body types (31), which likely plays a role in the underestimation of weight, especially for individuals with borderline obesity but have not yet approached morbid obesity. Individuals with a lower education background were also more likely to have poor weight perception.…”

Section: Discussionmentioning

confidence: 99%

“…The results of this analysis highlight the importance centering management efforts into improving weight awareness in NAFLD patients. At present, lifestyle management remains the only effective treatment measure in NAFLD which can additionally serve as a preventive measure for CVD disease ( 32 ). However, individuals with poor weight perception were less likely to exercise.…”

Section: Discussionmentioning

confidence: 99%

A poor perspective of self weight significantly increases adverse outcomes in non-alcoholic fatty liver disease (NAFLD)

Ng²,

Chew³

et al. 2022

Front. Med.

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BackgroundNon-alcoholic fatty liver disease (NAFLD) is prevalent amongst overweight and obese individuals, and weight loss remains the main mode of treatment for NAFLD patients. Weight perception plays a key role in the efficacy of such treatment. The current study aims to investigate the prevalence, associating factors and implications of poor weight perception amongst such individuals.MethodsAn analysis was done on data collected from NHANES between 1999 and 2018. Comparison was made between NAFLD individuals with and without poor weight perception in terms of prevalence, associated characteristics, and clinical outcomes. Multivariate analysis was used to compare effect size of adverse events associated with NAFLD individuals with poor weight perception.ResultsOf the 12,170 NAFLD patients, 19.2% (CI: 18.5 to 19.9%) had poor weight perception. Poor weight perception was significantly associated with lower education levels, reduced levels of exercise and unhealthier lipid profiles. There was an increased risk in all-cause mortality (HR: 1.18, CI: 1.00 to 1.38, p = 0.047), cardiovascular disease mortality (SHR: 1.33, CI: 1.03 to 1.71, p = 0.026), major adverse cardiovascular events (OR: 1.21 CI: 1.10 to 1.32, p < 0.001), and advanced fibrosis (OR: 1.30, CI: 1.03 to 1.64, p = 0.025) for individuals with poor weight perception.ConclusionThis study highlights the positive association between appropriate weight perception and better outcomes in individuals with NAFLD. Poor weight perception increased the risk of adverse events and decreased inclination toward seeking weight loss treatment. Greater emphasis should be placed on dealing with weight perception in individuals with NAFLD for better treatment outcomes.

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Comprehensive Review and Updates on Holistic Approach Towards Non-Alcoholic Fatty Liver Disease Management with Cardiovascular Disease

Cited by 25 publications

References 181 publications

The placebo response rate and nocebo events in obesity pharmacological trials. A systematic review and meta-analysis

The placebo response rate and nocebo events in obesity pharmacological trials. A systematic review and meta-analysis

Hypertension is prevalent in non-alcoholic fatty liver disease and increases all-cause and cardiovascular mortality

A poor perspective of self weight significantly increases adverse outcomes in non-alcoholic fatty liver disease (NAFLD)

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