The impact of modifiable risk factors on the long‐term outcomes of non‐alcoholic fatty liver disease

Paik, James; Deshpande, Rati; Golabi, Pegah; Younossi, Issah; Henry, Linda; Younossi, Zobair M.

doi:10.1111/apt.15580

Cited by 41 publications

(28 citation statements)

References 37 publications

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“…Further research is needed to determine which interventions are successful in decreasing cardiovascular mortality posttransplant. [39][40][41] The study limitations include its retrospective nature, the lack of clear diagnosis of NASH in early years of the study period, as well as the lack of systematic quality control in SRTR data. Given that, there is a chance of inconsistencies of medical history tracking across different transplant centers as well as changes in recording practices and diagnostic criteria with time.…”

Section: Discussionmentioning

confidence: 99%

Nonalcoholic Steatohepatitis Is the Most Rapidly Increasing Indication for Liver Transplantation in the United States

Younossi

Stepanova

Ong

et al. 2021

Clinical Gastroenterology and Hepatology

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338

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BACKGROUND & AIMS:The profile of chronic liver disease (CLD) in the United States has changed due to obesity trends and advances in treatment of viral hepatitis. We assessed liver transplant listing trends by CLD etiology. METHODS:Adult candidates for liver transplantation were selected from the Scientific Registry of Transplant Recipients (2002 through 2019. We calculated proportion trends for common CLD etiologies at time of placement on the wait list, including chronic infection with hepatitis B virus, chronic infection with hepatitis C virus (HCV), nonalcoholic steatohepatitis (NASH, including cryptogenic cirrhosis), alcohol-related liver disease (ALD) without or with chronic HCV infection, autoimmune hepatitis, primary biliary cholangitis, and primary sclerosing cholangitis, in patients with and without hepatocellular carcinoma (HCC). RESULTS:From the 168,441 patients with known etiology and non-acute liver failure on the liver transplant waitlist, 27,799 patients (16.5%) had HCC. In 2002, the most common etiologies in patients without HCC were chronic HCV infection (37%) and ALD (16%), whereas only 5% had NASH. Among patients with HCC, 58% had chronic HCV infection and 10% had ALD and only 1% had NASH. In 2019, among patients without HCC, NASH was the second leading indication for liver transplantation (28% of patients), after ALD (38% of patients). Among patients with HCC, chronic HCV infection remained the leading indication (40% of patients) but NASH (24% of patients) surpassed ALD (16% of patients) to become the second leading indication. NASH was the leading indication in women without HCC (34%), in patients older than 54 years (36%), and in patients on Medicare (41%). In trend analysis, NASH was the most rapidly increasing indication for liver transplantation in patients without HCC (Kendall tau[0.97; P < .001) and in patients with HCC (tau[0.94; P < .0001). CONCLUSIONS:In an analysis of data from the Scientific Registry of Transplant Recipients (2002 through 2019), we found NASH to be the second most common indication for liver transplant in 2019, and the fastest increasing indication. In 2019, NASH was the leading indication for liver transplantation among women without HCC.

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Section: Discussionmentioning

confidence: 99%

Nonalcoholic Steatohepatitis Is the Most Rapidly Increasing Indication for Liver Transplantation in the United States

Younossi

Stepanova

Ong

et al. 2021

Clinical Gastroenterology and Hepatology

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338

231

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“…After examining the full text of these 46 potentially eligible studies, we excluded 10 studies, mainly due to unsatisfactory inclusion criteria or unsatisfactory outcome measures (see appendix p10). [49][50][51][52][53][54][55][56][57][58] As a consequence of this exclusion, we identified 36 unique, observational studies for inclusion in the meta-analysis.…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

Non-alcoholic fatty liver disease and risk of fatal and non-fatal cardiovascular events: an updated systematic review and meta-analysis

Mantovani

Csermely

Petracca

et al. 2021

The Lancet Gastroenterology & Hepatology

297

214

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Background: Studies have reported a significant association between non-alcoholic fatty liver disease (NAFLD) and increased incidence of cardiovascular disease (CVD). However, the magnitude of the risk and whether this risk changes with the severity of NAFLD remains uncertain. We performed a meta-analysis of observational studies to quantify the magnitude of the association between NAFLD and risk of incident CVD events. Methods:We systematically searched PubMed, Scopus and Web of Science from database inception to July 1, 2021 to identify eligible observational studies, in which NAFLD was diagnosed by imaging, International Classification of Diseases codes, or liver biopsy. The primary outcomes were CVD death, nonfatal CVD events, or both. Data from selected studies were extracted, and meta-analysis was performed using random-effects models to obtain summary hazard ratios (HRs) with 95% CIs. The quality of the evidence was assessed with the Cochrane risk of bias tool. This study is registered on Open Science Framework, number osf.io/5z7gf. Findings:We identified 36 longitudinal studies with aggregate data on 5,802,226 middle-aged individuals of different countries and 99,668 incident cases of fatal and nonfatal CVD events over a median follow-up of 6.5 years. NAFLD was associated with a moderately increased risk of fatal or nonfatal CVD events (pooled random-effects HR 1.45, 95% CI 1.31-1.61; I 2 =86.2%).This risk markedly increased across the severity of NAFLD, especially the stage of fibrosis (pooled random-effects HR 2.50, 95% CI 1.68-3.72; I 2 =73.8%). All risks were independent of age, sex, adiposity measures, diabetes and other common cardiometabolic risk factors. Sensitivity analyses did not modify these results. Funnel plot did not show any significant publication bias.Interpretation: NAFLD is associated with a ~1.5-fold increased long-term risk of fatal or nonfatal CVD events. CVD risk is further increased with more advanced liver disease, especially with higher fibrosis stage. These results provide evidence that NAFLD may be an independent risk factor for CVD morbidity and mortality.Funding: None.

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“…NAFLD is also emerging as the leading cause of hepatocellular carcinoma (HCC), liver-related deaths and non-liver-related death such as those related cardiovascular comorbidity [8][9][10][11]. Attainment of cardiovascular health metrics has been shown to decrease all-cause mortality in persons with NAFLD [12], and weight loss is associated with clinically meaningful improvements in biomarkers of liver disease [13][14][15][16]. In fact, even a 5% reduction in BMI can greatly decrease liver fat and volume in patients with biopsy-proven NASH [15].…”

Section: Introductionmentioning

confidence: 99%

Discrepancies between actual weight, weight perception and weight loss intention amongst persons with NAFLD

et al. 2020

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Background. Currently, weight loss remains the main management strategy for NAFLD, but the weight loss intention and methods remain poorly characterized.Methods. We analysed data about the perception of weight status, intention and methods to lose weight amongst 3,822 persons with NAFLD (United States Fatty Liver Index ≥ 30) from the National Health and Nutrition Examination Survey, 2001-2014.Results. Only 53.9% of people with NAFLD intended to lose weight, 91.8% with perception of overweight and 8.2% with normal weight perception. Persons with perception of overweight or overweight/obese status were four times more likely to try to lose weight (adjusted odds ratios 3.9 and 4.2, respectively, both P < 0.0001). Younger age, women, higher educational level, Hispanic and blacks (versus whites) were significant independent factors associated with weight loss intention. Notably, ≤10% attended weight loss programme. Metabolic equivalent of task hours per week was significantly higher in whites who exercised to lose weight (vs. no exercise, P = 0.003) but not in other racial/ethnic groups. Interestingly, calorie intake was similar between those who dieted versus not (2056 vs. 1970 kcal/ day, P = 0.11). About 30% reported ≥ 10-lb weight loss, with 50% higher odds of success for men but there was no difference by race/ethnicity. Conclusion.Overweight or obese perception was a key driver in weight loss activities but was inconsistent with actual weight status and varied by race/ ethnicity and other sociodemographic factors. Weight loss programme is under-utilized and should take in account of weight perception training and culturally appropriate approach.

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The impact of modifiable risk factors on the long‐term outcomes of non‐alcoholic fatty liver disease

Cited by 41 publications

References 37 publications

Nonalcoholic Steatohepatitis Is the Most Rapidly Increasing Indication for Liver Transplantation in the United States

Nonalcoholic Steatohepatitis Is the Most Rapidly Increasing Indication for Liver Transplantation in the United States

Non-alcoholic fatty liver disease and risk of fatal and non-fatal cardiovascular events: an updated systematic review and meta-analysis

Discrepancies between actual weight, weight perception and weight loss intention amongst persons with NAFLD

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