Non‐alcoholic fatty liver disease patients attending two metropolitan hospitals in Melbourne, Australia: high risk status and low prevalence

George, Elena S.; Roberts, Stuart K.; Nicoll, Amanda; Reddy, Anjana; Paris, Tonya; Itsiopoulos, Catherine; Tierney, Audrey C.

doi:10.1111/imj.13973

Cited by 9 publications

(12 citation statements)

References 41 publications

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“…Taken together, the present results and data of Chow et al . confirm that it is potentially erroneous to assume that a single LSM that exceeds 12 kPa (but is less than 30 kPa) indicates the patient has “at least moderate fibrosis” in NAFLD: Alternatively, such cases may have severe steatosis and/or mild NASH with potential for an excellent response to lifestyle modification, even when only modest adjustments in weight and physical activity are achieved …”

Section: Resultssupporting

confidence: 70%

“…Table details the numerous studies that have proposed cutoff values for liver stiffness by FibroScan in NAFLD. While earlier studies often suggested that > 9.5 or 12.5 kPa indicates “at least moderate risk of significant liver fibrosis” or “high risk of cirrhosis in NAFLD,” more recent data indicate that the cutoff for advanced liver fibrosis in NAFLD is not the same as for viral hepatitis . Further, initial measurements may not reflect a stable change .…”

Section: Liver Stiffness Measurement In Non‐alcoholic Fatty Liver Dismentioning

confidence: 96%

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When the liver gets stiff, the tough get moving

Nguyen

Wardell

Chitturi

et al. 2020

J of Gastro and Hepatol

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Liver stiffness measurement (LSM) by FibroScan‐determined transient elastography is a noninvasive approach to estimate liver fibrosis severity. In non‐alcoholic fatty liver disease (NAFLD), advanced liver fibrosis is excluded by normal liver stiffness, but a wide range of cutoffs have been used to predict advanced liver fibrosis or cirrhosis. This may be partly because steatosis (measured by controlled attenuation parameter [CAP]) contributes to liver stiffness and also because LSM fluctuates in NAFLD. In a recent pivotal study, one‐third of patients with liver stiffness > 12.0 kPa showed reversal after 4–6 months; these cases did not have advanced liver fibrosis on biopsy. We performed serial FibroScans 6–36 months apart in 73 NAFLD patients, 38 with LSM > 10 kPa at entry. Those who lost ≥ 1 kg of weight (n = 31) significantly reduced liver stiffness (3.6 ± 6.1 vs 0.53 ± 4.1 kPa, P < 0.05) and CAP score (39 ± 63 dB/m of loss vs 24 ± 65 dB/m of gain, P < 0.05) compared with those who did not (n = 29). Patients who reported increased physical activity (n = 25) also reduced liver stiffness (3.6 ± 6 vs 0.35 ± 6 kPa) and CAP (20 ± 71 dB/m of loss vs 32 ± 71 dB/m of gain). Overall, those with improved LSM were significantly more likely to have lost weight and/or improved physical activity. These effects of lifestyle adjustments partly explain why a single measurement of 12.0 kPa is not a reliable cutoff for advanced liver fibrosis in NAFLD. In addition to repeating the study after 6–12 months, documentation of response to lifestyle advice and weight reduction should be determined before assuming any cutoff indicates advanced liver fibrosis. Despite this reservation about diagnostic accuracy, we consider that measurement of liver stiffness and CAP score serve to motivate patients to enact lifestyle modifications that can improve NAFLD severity.

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Section: Resultssupporting

confidence: 70%

Section: Liver Stiffness Measurement In Non‐alcoholic Fatty Liver Dismentioning

confidence: 96%

When the liver gets stiff, the tough get moving

Nguyen

Wardell

Chitturi

et al. 2020

J of Gastro and Hepatol

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“…We read with interest the article by George et al describing non‐alcoholic fatty liver disease (NAFLD) in liver clinics of two metropolitan Melbourne teaching hospitals . While their finding that obesity and glucose intolerance are the usual risk factors for significant liver disease with NAFLD is well supported by the literature, we were surprised that NAFLD formed only 7% of referrals to those clinics.…”

mentioning

confidence: 90%

“…Australia is well placed to conduct collaborative studies such as those needed to test promising biomarker and physical investigations that characterise those patients in need of major interventions. In the meantime, we strongly agree that greater public and professional awareness of fatty liver as a common accompaniment of overweight and metabolic obesity is needed . Given the strong links between NAFLD and risk of type 2 diabetes, cardiovascular disease and common cancers, even those cases in which the liver disease is minor can benefit enormously from lifestyle intervention, irrespective of whether referral to a liver clinic is activated or not.…”

mentioning

confidence: 96%

Non‐alcoholic fatty liver disease

Farrell

Wardell

Teoh

et al. 2019

Internal Medicine Journal

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“…NAFLD is a systemic condition, featuring metabolic, cardiovascular, and (hepatic/extrahepatic) cancer risks [1,2]. NAFLD is the most frequent cause of chronic liver injury in adults in developed countries [3,4]. About one-quarter of fatty liver cases develop NASH and over one-quarter of NASH patients develop severe fibrosis [1,5,6,7].…”

Section: Introductionmentioning

confidence: 99%

Overview of the Pathogenesis, Genetic, and Non-Invasive Clinical, Biochemical, and Scoring Methods in the Assessment of NAFLD

Kupčová

Fedelešová

Bulas

et al. 2019

IJERPH

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Nonalcoholic fatty liver disease (NAFLD) is the most prevalent chronic liver disease worldwide. It represents a range of disorders, including simple steatosis, nonalcoholic steatohepatitis (NASH), and liver cirrhosis, and its prevalence continues to rise. In some cases, hepatocellular carcinoma (HCC) may develop. The develop;ment of non-invasive diagnostic and screening tools is needed, in order to reduce the frequency of liver biopsies. The most promising methods are those able to exclude advanced fibrosis and quantify steatosis. In this study, new perspective markers for inflammation, oxidative stress, apoptosis, and fibrogenesis; emerging scoring models for detecting hepatic steatosis and fibrosis; and new genetic, epigenetic, and multiomic studies are discussed. As isolated biochemical parameters are not specific or sensitive enough to predict the presence of NASH and fibrosis, there is a tendency to use various markers and combine them into mathematical algorithms. Several predictive models and scoring systems have been developed. Current data suggests that panels of markers (NAFLD fibrosis score, Fib-4 score, BARD score, and others) are useful diagnostic modalities to minimize the number of liver biopsies. The review unveils pathophysiological aspects related to new trends in current non-invasive biochemical, genetic, and scoring methods, and provides insight into their diagnostic accuracies and suitability in clinical practice.

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Non‐alcoholic fatty liver disease patients attending two metropolitan hospitals in Melbourne, Australia: high risk status and low prevalence

Abstract: NAFLD constituted a minority of liver clinic patients, most of who were obese, insulin resistant and hypertensive, and many had an elevated liver stiffness measurement. NAFLD poses added adverse health outcomes to high-risk patients, and therefore, early detection is warranted.

Cited by 9 publications

References 41 publications

When the liver gets stiff, the tough get moving

When the liver gets stiff, the tough get moving

Non‐alcoholic fatty liver disease

Overview of the Pathogenesis, Genetic, and Non-Invasive Clinical, Biochemical, and Scoring Methods in the Assessment of NAFLD

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