The Spectrum and Impact of Metabolic Dysfunction in MAFLD: A Longitudinal Cohort Analysis of 32,683 Overweight and Obese Individuals

Chan, Kai En; Ng, Cheng Han; Fu, Clarissa Elysia; Quek, Jingxuan; Kong, Gwyneth; Goh, Yi Jie; Zeng, Rebecca Wenling; Tseng, Michael T.; Aggarwal, Manik; Nah, Benjamin; Chee, Douglas; Wong, Zhen Yu; Zhang, Sitong; Wang, Jiong‐Wei; Chew, Nicholas; Dan, Yock Young; Siddiqui, Mohammad Shadab; Noureddin, Mazen; Sanyal, Arun J.; Muthiah, Mark

doi:10.1016/j.cgh.2022.09.028

Cited by 16 publications

(16 citation statements)

References 31 publications

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“…The greatest cardiometabolic concern for participants was the chance of getting a stroke, with the least concern shown for NAFLD. We postulate that the lack of concern for NAFLD is a result of the following factors; first, there is an underdiagnosis of NAFLD by physicians across the globe ( 64 – 67 ), possibly contributed by the knowledge gap in the identification and diagnosis of NAFLD, as well as the limited treatment options in NAFLD ( 63 , 68 , 69 ). Second, less media portrayal and patient education on NAFLD, relative to that of stroke and coronary artery disease, may have been contributing factors ( 70 , 71 ).…”

Section: Discussionmentioning

confidence: 99%

General Public’s knowledge, awareness, and perception of Cardiometabolic diseases: data from a Singapore study population

et al. 2023

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BackgroundHealth literacy and illness perception play crucial roles in tackling the cardiometabolic disease epidemic. We aim to compare the attitudes, knowledge, self-perceived risks and actions taken, between individuals with and without metabolic risk factors (MFs).MethodsFrom 5 June to 5 October 2022, participants of the general public were invited to complete a self-administered questionnaire. MF status was defined as the presence of hypertension, hyperlipidemia, diabetes mellitus and/or current/previous smoking. Participants were assessed based on four categories (knowledge-based, attitude-based, perceived risk, and action-based) of questions pertaining to four cardiometabolic diseases – diabetes mellitus, hypertension, hyperlipidemia, and non-alcoholic fatty liver disease.ResultsA total of 345 participants were enrolled, of whom 34.5% had at least one MF. Compared to those without MFs, participants with MFs had lower knowledge scores, but higher perceived risk scores across all cardiometabolic diseases. The largest knowledge gap pertained to hypertension-related questions. After adjustment, linear regression demonstrated that the presence of MFs (β:2.752, 95%CI: 0.772–4.733, p = 0.007) and higher knowledge scores (β:0.418, 95%CI: 0.236–0.600, p < 0.001) were associated with higher perceived risk. Despite increased perceived risk in those with MFs, this translated to only few increased self-reported preventive actions, when compared to those without MFs, namely the reduction in red meat/processed food consumption (p = 0.045) and increase in fruits/vegetables consumption (p = 0.009).ConclusionThis study identified a vulnerable subpopulation living with MFs, with high perceived risks, and discordant levels of knowledge and preventive actions taken. Nationwide efforts should be channeled into addressing the knowledge-to-action gap.

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Section: Discussionmentioning

confidence: 99%

General Public’s knowledge, awareness, and perception of Cardiometabolic diseases: data from a Singapore study population

et al. 2023

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“…Extensive lines of evidence demonstrate that T2DM is associated with increased risks of cancer events and cardiovascular mortality, as exemplified by a comprehensive study involving 32,683 overweight and obese individuals from the United States National Health and Nutrition Examination Survey (NHANES). 26 Analogously, the deleterious impact of T2DM is also evident within the CHB population. A Korean cohort study comprising 317,856 CHB patients, with a median follow-up period of 8.5 years, revealed that metabolic risk factors, encompassing T2DM, significantly augmented the risks of non-HCC malignancies and all-cause mortality.…”

Section: The Impact Of T2dm On Chbmentioning

confidence: 98%

The interplay between chronic hepatitis B and diabetes mellitus: A narrative and concise review

Huang,

Kao

2023

The Kaohsiung J of Med Scie

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Type 2 diabetes mellitus (T2DM) is a prevalent metabolic disorder among individuals with chronic hepatitis B (CHB), contributing to additional adverse impacts on both hepatic and extrahepatic systems. Existing evidence suggests a potential positive association between CHB and the development of insulin resistance and T2DM. The presence of T2DM in CHB patients is associated with an increased risk of liver fibrosis, cirrhosis, decompensation, and hepatocellular carcinoma (HCC) occurrence. Moreover, it elevates the risk of non‐liver cancers and all‐cause mortality in this population. T2DM also serves as the key element in metabolic dysfunction‐associated steatotic liver disease, which is prevalent in the CHB population. Although specific guidelines for managing T2DM in CHB patients have not been proposed, some studies indicated that intensive glycemic control may benefit the prognosis of these patients. Additionally, specific antidiabetic agents, such as metformin and thiazolidinediones, promise to reduce HCC risk. However, unresolved questions, including the optimal glycemic control target and the selection of antidiabetic agents for CHB patients, remain and thus warrant further investigations through well‐designed prospective trials. Implementing a standardized protocol encompassing regular monitoring, risk stratification, and early intervention using a multidisciplinary framework may improve the outcomes of diabetic CHB patients.

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“…In a prospective study of 5754 CHB patients receiving NA in China, central obesity was associated with a two-fold risk of HCC before and after PSM 37 . Among patients with confirmed MAFLD, the additive metabolic risk abnormalities, especially DM, are known to be associated with higher cardiovascular, cancer, and all-cause mortality 70 . Similarly, in a recent Korean nationwide cohort study of 317856 CHB patients, the metabolic risk factor burden increased the risks of HCC, non-HCC cancers, and all-cause mortality in a dose-dependent manner 71 .…”

Section: Aggressive Correction Of Metabolic Dysfunction In Chb Patientsmentioning

confidence: 99%

Chronic hepatitis B with concurrent metabolic dysfunction-associated fatty liver disease: Challenges and perspectives

Huang¹,

Liu²

2023

Clin Mol Hepatol

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The prevalence of metabolic dysfunction-associated fatty liver disease (MAFLD) has increased among the general population and chronic hepatitis B (CHB) patients worldwide. Although fatty liver disease is a well-known risk factor for adverse liver outcomes like cirrhosis and hepatocellular carcinoma (HCC), its interactions with the hepatitis B virus (HBV) and clinical impacts seem complex.The presence of hepatic steatosis may suppress HBV viral activity, potentially leading to attenuated liver injury. In contrast, the associated co-morbidities like diabetes mellitus or obesity may increase the risk of developing adverse liver outcomes. These findings implicate that components of MAFLD may have diverse effects on the clinical manifestations of CHB. To this end, a clinical strategy is proposed for managing patients with concurrent CHB and MAFLD. This review article discusses the updated evidence regarding disease prevalence, interactions between steatosis and HBV, clinical impacts, and management strategies, aiming at optimizing holistic health care in the CHB population.

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The Spectrum and Impact of Metabolic Dysfunction in MAFLD: A Longitudinal Cohort Analysis of 32,683 Overweight and Obese Individuals

Cited by 16 publications

References 31 publications

General Public’s knowledge, awareness, and perception of Cardiometabolic diseases: data from a Singapore study population

General Public’s knowledge, awareness, and perception of Cardiometabolic diseases: data from a Singapore study population

The interplay between chronic hepatitis B and diabetes mellitus: A narrative and concise review

Chronic hepatitis B with concurrent metabolic dysfunction-associated fatty liver disease: Challenges and perspectives

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