Significant burden of nonalcoholic fatty liver disease with advanced fibrosis in the US: a cross‐sectional analysis of 2011‐2014 National Health and Nutrition Examination Survey

Wong, Robert J.; Liu, B.; Bhuket, Taft

doi:10.1111/apt.14327

Cited by 86 publications

(70 citation statements)

References 35 publications

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“…Non‐alcoholic fatty liver disease is one of the most common forms of chronic liver disease, affecting 25%‐30% of the United States' population . Weight loss through lifestyle changes is a proven therapy for this highly prevalent disease.…”

Section: Discussionmentioning

confidence: 99%

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: Discussionmentioning

confidence: 99%

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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“…This is of pivotal importance, since several studies identified advanced fibrosis and cirrhosis— defined as stage 3 and 4 fibrosis in the histological classification— as the relevant predictor of overall mortality and liver related events . In addition to the individual disease burden, the large number of patients with NAFLD with potential for progressive liver disease creates challenges for health care‐systems including potential socio‐economic expenses . The identification of patients with advanced fibrosis is of great important to encourage life‐style changes or offer medical interventions in this patient population.…”

Section: Introductionmentioning

confidence: 99%

Predictors of advanced fibrosis in non‐cirrhotic non‐alcoholic fatty liver disease in Germany

Labenz

Huber

Kalliga

et al. 2018

Aliment Pharmacol Ther

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Summary Background Advanced fibrosis has been established as the most important predictor of overall mortality in patients with non‐alcoholic fatty liver disease (NAFLD). In contrast to cirrhosis, advanced, non‐cirrhotic NAFLD is difficult to identify and data from Germany are lacking. Aim To identify clinical factors associated with advanced, non‐cirrhotic fibrosis. Methods Patients were recruited in the prospectively enrolling European NAFLD Registry. Clinical characteristics and the performance of non‐invasive surrogate scores compared with vibration‐controlled transient elastography are reported. Results Two hundred and sixty‐one patients with non‐cirrhotic NAFLD on liver biopsy (mean age 51 years, equal sex distribution) were included. The prevalence of stage 3 fibrosis on liver biopsy was 15.7%. These patients were significantly older (57 vs 50 years, P < 0.01), had a higher body mass index (32.3 vs 30.5, P < 0.05), and more frequent arterial hypertension (78% vs 50%, P = 0.001) and type 2 diabetes (61% vs 24.1%, P < 0.001). On multivariate logistic regression, diabetes (OR = 4.68, 95% CI 2.17‐10.10) and hypertension (OR = 2.91, 95% CI 1.12‐7.18) were independent predictors of advanced fibrosis. Comedication included metformin in 50% and insulin in 33% of patients with diabetes. Despite the presence of cardiovascular risk factors, the use of statins was low. Liver stiffness measurement identified advanced fibrosis with an AUROC of 0.81 (95% CI 0.72‐0.91). The performance of NAFLD fibrosis score, Fibrosis‐4, and AST to platelet ratio index were lower with AUCs of 0.74, 0.71, and 0.67, respectively. Conclusions The prevalence of metabolic comorbidities in a German population with non‐cirrhotic biopsy‐proven NAFLD is high. While the examined scores exhibit an acceptable specificity, liver stiffness measurement appeared to be superior to blood‐based non‐invasive surrogate scores in ruling out advanced fibrosis.

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“…It affects over 600 000 adults in the USA, with estimates that an additional five million have at least bridging fibrosis . These numbers will rise as baby boomers with chronic hepatitis C age and the incidence of nonalcoholic fatty liver disease grows . Indeed, patients with cirrhosis seeking medical attention has increased by 59% over the past decade, and cirrhosis is now the 12 th leading cause of death in the USA .…”

Section: Introductionmentioning

confidence: 99%

“…1,2 These numbers will rise as baby boomers with chronic hepatitis C age and the incidence of nonalcoholic fatty liver disease grows. 3 Indeed, patients with cirrhosis seeking medical attention has increased by 59% over the past decade, 4 and cirrhosis is now the 12 th leading cause of death in the USA. 5 Compounding the problem of rising prevalence, cirrhosis is an expensive condition, with an estimated annual healthcare cost of $2 billion dollars in the USA.…”

Section: Introductionmentioning

confidence: 99%

Optimizing medication management for patients with cirrhosis: Evidence‐based strategies and their outcomes

Thomson

Lok

Tapper

2018

Liver International

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Cirrhosis is a morbid condition associated with frequent hospitalizations and high mortality. Management of cirrhosis requires complex medication regimens to treat underlying liver disease, complications of cirrhosis and comorbid conditions. This review examines the complexities of medication management in cirrhosis, barriers to optimal medication use, and potential interventions to streamline medication regimens and avoid medication errors. A literature review was performed by searching PUBMED through December 2017 and article reference lists to identify articles relevant to medication management, complications, adherence, and interventions to improve medication use in cirrhosis. The structural barriers in cirrhosis include sheer medication complexity related to the number of medications and potential for cognitive impairment in this population, faulty medication reconciliation and limited adherence. Tested interventions have included patient self-education, provider driven patient education, intensive case management including medication blister packs and smartphone applications. Initiatives are needed to improve patient, caregiver and provider education on appropriate use of medications in patients with cirrhosis. A multidisciplinary team should be established to coordinate care with close monitoring, address patient and caregiver concerns, and to provide timely access to outpatient evaluation of urgent/complex issues. Future studies evaluating the clinical outcomes and cost effectiveness of interventions are needed.

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Significant burden of nonalcoholic fatty liver disease with advanced fibrosis in the US: a cross‐sectional analysis of 2011‐2014 National Health and Nutrition Examination Survey

Abstract: NAFLD represents a major healthcare burden among US adults with as many as 5 million adults estimated to have NAFLD with ≥F3 fibrosis. Age and the components of the metabolic syndrome are independently associated with higher risk of fibrosis.

Cited by 86 publications

References 35 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

Predictors of advanced fibrosis in non‐cirrhotic non‐alcoholic fatty liver disease in Germany

Optimizing medication management for patients with cirrhosis: Evidence‐based strategies and their outcomes

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