Identifying Practice Gaps to Optimize Medical Care for Patients with Nonalcoholic Fatty Liver Disease

Wieland, Amanda; Quallick, Matthew; Truesdale, Aimee; Mettler, Pamela; Bambha, Kiran

doi:10.1007/s10620-013-2740-8

Cited by 47 publications

(49 citation statements)

References 22 publications

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“…Taken together, this pattern of care reflects low disease awareness among patients and providers, even in the face of multiple metabolic risk factors . These care patterns also reflect perceptions regarding the clinical significance and treatment options for NAFLD held by many providers . This low rate of referral to GI/Hepatology is in line with data from prior studies where 71% of providers reported that they did not refer patients with suspected NAFLD to GI/Hepatology .…”

Section: Discussionsupporting

confidence: 73%

Impact of a structured lifestyle programme on patients with metabolic syndrome complicated by non‐alcoholic fatty liver disease

Konerman

Walden

Joseph

et al. 2018

Aliment Pharmacol Ther

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Summary Background Lifestyle interventions are first‐line therapy for non‐alcoholic fatty liver disease (NAFLD). Aims To examine the prevalence of NAFLD among participants of the University of Michigan Metabolic Fitness (MetFit) Programme and to assess the impact of this programme on weight, metabolic and liver‐related parameters among patients with and without NAFLD. Methods Adults who completed the programme between 2008 and 2016 were included. Clinical and laboratory data were collected at enrolment, and at 12 and 24 weeks. NAFLD was defined based on liver biopsy, imaging or clinical diagnosis. Results The cohort (N = 403; 253 12‐week, 150 24‐week) consisted primarily of middle‐aged (median 54 years) white (88%) men (63%) with severe obesity (median BMI 37.4). 47.6% met criteria for NAFLD. At baseline, NAFLD patients were younger (52 vs 55 years), had higher weights and more metabolic derangements (higher fasting insulin and triglyceride, lower high‐density lipoprotein‐cholesterol). At programme completion, 30% achieved weight reduction ≥5%, 62% resolution of hypertriglyceridaemia, 33% resolution of low HDL, 27% resolution of impaired fasting glucose and 43% normalisation of alanine aminotransferase. Endpoints were unaffected by NAFLD. Longer programme duration (OR 6.7, 95% CI 3.6‐12.3) and white race (OR 3.83, 95% CI 1.04‐1.76) were independent predictors of ≥5% weight loss. Conclusions Nearly half of the patients referred to a structured lifestyle programme for metabolic syndrome had NAFLD. Although baseline metabolic derangements were more pronounced among NAFLD patients, the programme was equally efficacious in achieving weight loss and resolving metabolic syndrome components. Programme duration was the most important predictor of response.

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Section: Discussionsupporting

confidence: 73%

Impact of a structured lifestyle programme on patients with metabolic syndrome complicated by non‐alcoholic fatty liver disease

Konerman

Walden

Joseph

et al. 2018

Aliment Pharmacol Ther

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“…10 However, NAFLD is one of the most common chronic liver diseases in the United States today that, in a subset of individuals, leads to cirrhosis, and is projected to become the leading indication for liver transplantation by the year 2020. Of the small percentage of patients who had heard of NAFLD (18%), less than half (43%) were informed by their physicians or other medical providers.…”

Section: Discussionmentioning

confidence: 99%

Low Awareness of Nonalcoholic Fatty Liver Disease Among Patients at High Metabolic Risk

Wieland¹,

Mettler

McDermott

et al. 2015

Journal of Clinical Gastroenterology

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“…Thus, in patients with NAFLD, an improvement of diagnostic approach alertness is required for underrating the prevalence and the important clinical condition of NAFLD. Clinicians have developed adequate screening [102] . Finally, it is important to underline that ultrasonography (US) is likely inadequate in several subgroups of patients (obese, Child Pugh B or C, alcohol and NASH related cirrhotic) and does not permit the exclusion of the presence of HCC [103] .…”

Section: Hcc In Nafld Cirrhosismentioning

confidence: 99%

Fat and hepatocellular carcinoma

Balsano¹,

Porcu²,

Sideri³

et al. 2018

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Obesity and diabetes are associated with the onset of hepatocellular carcinoma (HCC). These two illnesses correlate also with the development of non-alcoholic fatty liver disease (NAFLD). Currently, NAFL is considered the leading form of chronic liver disease in the Western industrialized countries. Insulin resistance is the common pathogenic factor among these three pathologies. NAFL is characterized by fat accumulation in the liver that involves greater than 5% of the liver parenchyma with no evidence of hepatocyte injury. However, NAFL may progress toward non-alcoholic steatohepatitis that in turn may lead to advanced fibrosis, cirrhosis and HCC. It is alarming that NAFLD related HCC has been, at present, considered as a growing burden worldwide, and its prevalence is tending to further increase together with the increasing incidence of obesity and diabetes. Worthy of note is that in the presence of chronic accumulation of fat in the liver it has been reported the emergence of HCC during chronic liver disease in absence of liver cirrhosis, usually the major risk factor for the development of HCC. Thus, in the future NAFLD related HCCs will place a growing strain on health-care systems from the need for their management. Unfortunately, most of the NAFLD related HCC patients are diagnosed at advanced stages and are characterized by a poor prognosis, because they are ineligible to radical treatments. Thus, it is urgent to boost up new screening policies to make early diagnoses, as well as to develop preventive-therapeutic strategies.

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Identifying Practice Gaps to Optimize Medical Care for Patients with Nonalcoholic Fatty Liver Disease

Cited by 47 publications

References 22 publications

Impact of a structured lifestyle programme on patients with metabolic syndrome complicated by non‐alcoholic fatty liver disease

Impact of a structured lifestyle programme on patients with metabolic syndrome complicated by non‐alcoholic fatty liver disease

Low Awareness of Nonalcoholic Fatty Liver Disease Among Patients at High Metabolic Risk

Fat and hepatocellular carcinoma

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