Does knowledge of liver fibrosis affect high-risk drinking behaviour (KLIFAD)? protocol for a feasibility randomised controlled trial

Subhani, Mohsan; Jones, Katy A.; Sprange, Kirsty; Rennick-Egglestone, Stefan; Knight, Holly; Morling, Joanne R; Enki, Doyo; Wragg, Andrew; Ryder, Stephen D.

doi:10.1136/bmjopen-2021-054954

Cited by 8 publications

(12 citation statements)

References 26 publications

(30 reference statements)

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“…In addition, assessing genetic risk factors may complement the stratification of disease progression along VCTE and non‐invasive markers in individual patients with SLD 32 . Knowledge about liver disease, using VCTE amongst others, would empower patients to act upon their risk profile by implementing lifestyle changes as recently seen in patients with ALD 33 . It can be expected that this will also be of benefit in patients with a high metabolic risk profile.…”

Section: Discussionmentioning

confidence: 99%

Obesity and harmful alcohol consumption are predictors for advanced liver disease in the disease management program for type 2 diabetes

Michel,

Doll,

Albert

et al. 2024

UEG Journal

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BackgroundType 2 diabetes mellitus (T2DM) is a major risk factor for advanced liver disease. The aim of this prospective cohort study was to assess the prevalence and associated risk factors of liver fibrosis and cirrhosis in primary care centers participating in the diabetes disease management program (DMP) in Germany.MethodsA total of 175 participants with the diagnosis of T2DM were enrolled in two primary care centers. Steatotic liver disease (SLD; hepatic steatosis, ≥275 dB/m), fibrosis (≥8 kPa), and cirrhosis (≥15 kPa) were assessed non‐invasively using vibration‐controlled transient elastography. Multivariable logistic regression analysis was performed to identify clinical predictors of fibrosis and cirrhosis. The AUDIT questionnaire was used to screen for alcohol consumption, and a score ≥8 was considered harmful alcohol consumption.ResultsThe majority of participants were male (62%), and the median age was 66 years (interquartile range 59; 71). The median body mass index was 31.1 kg/m2, with 58.9% of the participants being obese. Harmful alcohol consumption was prevalent in 8.0% and 20.0% of the entire cohort and in those with cirrhosis, respectively. The prevalence of SLD, fibrosis, and cirrhosis was 77.1%, 42.3%, and 12.0%, respectively. In multivariable logistic regression analysis, obesity, and harmful alcohol consumption were associated with the highest odds of fibrosis (odds ratio [OR] 5.198, 95% confidence interval [CI] 2.269–11.908) and cirrhosis (OR 5.615, 95% CI 1.274–24.756), respectively.ConclusionThe prevalence of fibrosis and cirrhosis in patients seen in the diabetes DMP in Germany is high. Obesity and harmful alcohol consumption increase the risk of fibrosis and cirrhosis in people with T2DM. Screening for advanced liver disease and associated risk factors within the DMP program may reduce the liver disease burden in this high‐risk population.

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Section: Discussionmentioning

confidence: 99%

Obesity and harmful alcohol consumption are predictors for advanced liver disease in the disease management program for type 2 diabetes

Michel,

Doll,

Albert

et al. 2024

UEG Journal

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“…The KLIFAD trial is investigating the feasibility of integrating transient elastography (TE) into community alcohol services to facilitate early diagnosis of liver disease and promote positive change in addictive behaviours (Subhani et al, 2023). Fibrosis is the medical term for the scarring of the liver.…”

Section: Methodsmentioning

confidence: 99%

Application and Extension of the Alcohol Recovery Narratives Conceptual Framework

Subhani,

Talat,

Knight

et al. 2023

Qual Health Res

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Recovery narratives are personal stories of health problems and recovery. A systematic review proposed a conceptual framework characterising alcohol misuse recovery narratives, consisting of eight principal dimensions, each with types and subtypes. The current study aims to apply and extend this preliminary conceptual framework. Semi-structured interviews were conducted to collect alcohol misuse recovery narratives from adult participants. A two-stage inductive and deductive thematic analysis approach was used to assess the relevance of the dimensions and types included in the preliminary conceptual framework and identify new components. The sample consisted of 11 participants from diverse socioeconomic backgrounds who had previously displayed varying degrees of alcohol misuse. All conceptual framework dimensions (genre, identity, recovery setting, drinking trajectories, drinking behaviours and traits, stages, spirituality and religion, and recovery experience) were present in the collected narratives. Three dimensions were extended by adding types and subtypes. Whilst the existing conceptual framework fitted the collected narratives, a new dimension describing the alcohol environment was required to fully characterise narratives. Types included in the alcohol environment dimension were policy and practice and social dynamics. The extended framework could guide the production of resources enabling clinicians to engage with narratives shared by their clients.

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“…There is work in progress investigating the role for ARLD assessment as part of an intervention for AUD 53 and a recent NHS quality target (CQUIN CCG9) has led to increased assessment for ARLD in people presenting to acute hospital care which is expected to generate useful data. 22 There is much scope to improve the response in non-hepatology settings to abnormal liver function tests and great progress being made in this realm.…”

Section: Implications For Future Researchmentioning

confidence: 99%

Proactive case finding of alcohol‐related liver disease in high‐risk populations: A systematic review

Archer,

Phillips,

Subhani

et al. 2024

Liver International

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BackgroundAlcohol‐related liver disease (ARLD) is often diagnosed at a late stage when mortality is unacceptably high. Earlier identification of ARLD may lead to reduced alcohol intake, participation in hepatocellular carcinoma surveillance and reduction in liver‐related morbidity and mortality. People with alcohol use disorder (AUD) are at highest risk of ARLD. The aim of this systematic review was to understand the yield of proactive screening for ARLD amongst high‐risk groups.MethodsEmbase, Medline, Scopus and grey literature were searched for studies describing proactive assessment for alcohol‐related liver disease in people with a history of alcohol excess or diagnosed AUD. Outcomes of interest were fibrosis and cirrhosis detection rates, clinical outcomes, portal hypertension evaluation, attendance at follow‐up and cost‐effectiveness.ResultsFifteen studies were identified for inclusion from 1115 returned by the search. Four key settings for patient engagement were identified as inpatient addiction services, outpatient addiction services, general acute hospital admissions and community outreach. Of these, acute hospital admissions were the highest yield for cirrhosis at 10.8%–29.6% and community outreach the lowest was 1.2%–2.3%.ConclusionsTargeted fibrosis assessment of high‐risk populations for ARLD is feasible to conduct and identifies a proportion of patients at risk of advanced liver disease. The highest yield is amongst inpatients admitted with AUD. Prospective work is needed to establish which are the most effective and acceptable screening methods and the impact on long‐term outcomes.

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Does knowledge of liver fibrosis affect high-risk drinking behaviour (KLIFAD)? protocol for a feasibility randomised controlled trial

Cited by 8 publications

References 26 publications

Obesity and harmful alcohol consumption are predictors for advanced liver disease in the disease management program for type 2 diabetes

Obesity and harmful alcohol consumption are predictors for advanced liver disease in the disease management program for type 2 diabetes

Application and Extension of the Alcohol Recovery Narratives Conceptual Framework

Proactive case finding of alcohol‐related liver disease in high‐risk populations: A systematic review

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