Nonalcoholic Fatty Liver Disease is Underrecognized in the Primary Care Setting

Blais, Pierre; Husain, Nisreen; Kramer, Jennifer R.; Kowalkowski, Marc; El–Serag, Hashem B.; Kanwal, Fasiha

doi:10.1038/ajg.2014.134

Cited by 110 publications

(98 citation statements)

References 17 publications

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“…We believe that our case definition for NAFLD captures those with clinically apparent and relevant NAFLD; the majority of whom remain unrecognized and undiagnosed in routine practice. 18 It is possible that some patients with clinically significant NAFLD may have persistently normal biochemistries during their entire clinical course at the VA, particularly if early in the disease process or if they were first seen at the VA towards the end of our study period, and we missed these patients. We also excluded HCV and HBV cases with coexistent NAFLD, thus likely underestimating the true burden of NAFLD.…”

Section: Discussionmentioning

confidence: 99%

Trends in the Burden of Nonalcoholic Fatty Liver Disease in a United States Cohort of Veterans

Kanwal

Kramer

Duan

et al. 2016

Clinical Gastroenterology and Hepatology

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134

108

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Background & Aims Nonalcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver disease in the United States (US). However, few data are available on recent trends in the incidence and prevalence of NAFLD in the US. Methods We analyzed the national Veterans Administration (VA) databases from 2003 to 2011 and calculated the age-adjusted prevalence and incidence of NAFLD for the overall sample of patients and by demographic subgroups. We used a previously validated algorithm to define NAFLD, based on persistent increases in levels of liver enzymes in the absence of positive results from tests for hepatitis C or hepatitis B, or evidence of excessive alcohol use. Results Of the 9,784,541 patients with at least 1 visit to the VA between 2003 and 2011, 1,330,600 patients (13.6%) had NAFLD. The annual incidence rates of NAFLD remained stable (from 2.2% to 3.2%) over the study duration. The prevalence of NAFLD increased from 6.3% in 2003 (95% confidence interval, 6.26%–6.3%) to 17.6% in 2011 (95% confidence interval, 17.58%–17.65%)—a 2.8-fold increase. The incidence and prevalence increased at significantly greater rates in patients younger than 45 years old vs older patients. Conclusions In a US population, the annual incidence of NAFLD ranges from 2% to 3%. The prevalence of NAFLD more than doubled from 2003 through 2011; it is likely to continue to increase, due to a steady overall incidence coupled with a rising incidence in younger individuals.

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Section: Discussionmentioning

confidence: 99%

Trends in the Burden of Nonalcoholic Fatty Liver Disease in a United States Cohort of Veterans

Kanwal

Kramer

Duan

et al. 2016

Clinical Gastroenterology and Hepatology

Self Cite

134

108

View full text Add to dashboard Cite

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“…Specifically, due to the westerni- zation of lifestyle and the aging population, the prevalence of NAFLD, closely related with metabolic disorders such as central obesity, hypertriglyceridemia and insulin resistance, has witnessed a rapid increase in Asia [16,17]. Most NAFLD patients do not present specific symptoms, particularly at the early stage, which hinders prevention and early detection [18]. Even though liver biopsy is regarded as the gold standard for liver steatosis, it is not routinely performed due to its invasive procedure and frequent sampling error [1,19].…”

Section: Discussionmentioning

confidence: 99%

Validation of simple indexes for nonalcoholic fatty liver disease in western China: a retrospective cross-sectional study

Zhu

Zhang

et al. 2018

Endocr J

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Abstract. Various noninvasive algorithms have been developed for predicting the presence of nonalcoholic fatty liver disease (NAFLD). The evaluation of the indexes' diagnostic performance has been reported in Europe and Asia over the past decade; however, external validation of them in China is rare. This study was aimed to evaluate various indexes for NAFLD in western China. It was a retrospective cross-sectional study, using data from a large-scale health check-up project at Sichuan provincial hospital. Receiver operating characteristic (ROC) curves of eight indexes, including the fatty liver index (FLI), the hepatic steatosis index, lipid accumulation product and etc., were developed to predict ultrasonographic NAFLD. There were 13,122 subjects in this study (2,692 NAFLD patients and 10,430 non-NAFLD participants). The area under ROC curve of FLI for predicting NAFLD was 0.880 (95% confidence interval, 0.874-0.886), which was significantly higher than other seven indexes. Accuracy, sensitivity and specificity of FLI for NAFLD were good (cut-off value = 30, 0.782, 0.832, 0.770 and cut-off value = 60, 0.838, 0.443, 0.940, respectively). Furthermore, FLI also presented advantages in expenditure and accessibility, compared with other indexes. It supports FLI as an easily accessible index for physicians and a reliable predictor for NAFLD screening in western China.

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“…In a study of 251 patients with NAFLD, 54 (21.5%) had NAFLD mentioned as a possible diagnosis, 37 (14.7%) were counseled regarding diet and exercise, and 26 (10.4%) were referred to a specialist. 29 With the prevalence of NAFLD increasing in the US and worldwide, unrecognized cirrhosis is likely to become a larger problem. 30 …”

Section: Identification Of At-risk Patients Based On Epidemiology Fimentioning

confidence: 99%

Hepatocellular Carcinoma From Epidemiology to Prevention: Translating Knowledge into Practice

Singal

El–Serag

2015

Clinical Gastroenterology and Hepatology

447

369

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Hepatocellular carcinoma (HCC) is the 3rd leading cause of cancer-related death worldwide and one of the leading causes of death in patients with cirrhosis.1]HCC incidence in the United States (US) has more than doubled over the past 2 decades and is anticipated to continue increasing over the next 20 y, due to the growing number of patients with advanced hepatitis C virus (HCV) and/or non-alcoholic steatohepatitis (NASH). At its current pace, HCC is projected to surpass breast and colorectal cancer to become the 3rd leading cause of cancer-related death in the US by 2030.2 Currently only 46% of HCC cases are diagnosed at an early stage and most do not receive curative therapy.2 Epidemiologic and clinical studies have identified many factors that affect risk for HCC and can be used to identify at-risk patients and implement prevention measures. Although several advances in HCC prevention, early detection, and diagnosis are efficacious and could reduce the incidence and mortality of HCC, widespread dissemination and successful implementation are essential for these strategies to be effective in clinical practice. Challenges include limited recognition of at-risk patients, availability of well-validated risk stratification measures, and surveillance in high-risk groups.

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Nonalcoholic Fatty Liver Disease is Underrecognized in the Primary Care Setting

Abstract: Most patients in care who may have NAFLD are not being recognized and evaluated for this condition. Our data suggest that providers may be using an incorrect heuristic in delivering NAFLD care by concentrating on those with high ALT levels.

Cited by 110 publications

References 17 publications

Trends in the Burden of Nonalcoholic Fatty Liver Disease in a United States Cohort of Veterans

Trends in the Burden of Nonalcoholic Fatty Liver Disease in a United States Cohort of Veterans

Validation of simple indexes for nonalcoholic fatty liver disease in western China: a retrospective cross-sectional study

Hepatocellular Carcinoma From Epidemiology to Prevention: Translating Knowledge into Practice

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