Metabolic dysfunction-associated steatotic liver disease and the risk of mortality in individuals with type 2 diabetes: a systematic review and meta-analysis.

The systematic review aimed to assess the risks of metabolic dysfunction-associated steatotic liver disease (MASLD) on all-cause and cause-specific mortality in patients with type 2 diabetes (T2DM). EMBASE and MEDLINE were searched from inception to June 2022 for observational studies examining the relationship between MASLD and the risk of mortality among T2DM patients. Meta-analysis was conducted using random-effects models with hazard ratios (HRs) to quantify the risk of mortality. A total of 5877 articles were screened, and ultimately, 12 eligible studies encompassing 368 528 T2DM patients, with a median follow-up of 8.9 years (interquartile range, 4.7-14.5), were included. Our analysis revealed a significant association between MASLD and an increased risk of all-cause mortality in T2DM patients [HR 1.28; 95% confidence interval (CI), 1.05-1.58; I 2  = 90%]. Meta-regression analyses did not show significant effects of mean age, mean BMI, and percentage of smokers, hypertension, and hyperlipidemia on the association between MASLD and the risk of all-cause mortality. However, we found that MASLD was not significantly associated with mortality related to cardiovascular diseases (HR 1.05; 95% CI, 0.82-1.35; I2  = 0%) or cancer (HR 1.21; 95% CI, 0.41-3.51; I 2  = 79%) among patients with T2DM. No publication bias was observed. This comprehensive meta-analysis provides substantial evidence supporting a significant association between MASLD and an increased risk of all-cause mortality among the T2DM population. These findings underscore the potential benefits of screening for MASLD in T2DM patients, aiding in the early identification of high-risk individuals and enabling risk modification strategies to improve survival.

Lean non-alcoholic fatty liver disease and the risk of all-cause mortality: An updated meta-analysis.

INTRODUCTION AND OBJECTIVES: Cohort studies reported controversial results regarding the long-term prognosis of patients with lean non-alcoholic fatty liver disease (NAFLD) compared to non-lean NAFLD patients. This updated meta-analysis aimed to estimate the magnitude of the association between lean body mass index and all-cause mortality risk in NAFLD patients. MATERIALS AND METHODS: We systematically searched the EMBASE and MEDLINE databases from inception to March 2023 to identify observational studies that reported hazard ratio (HR) for all-cause mortality of patients with lean NAFLD versus those with non-lean, overweight, or obese NAFLD. Multivariable-adjusted hazard ratios (HRs) for all-cause mortality were pooled using a random effects model. RESULTS: Fourteen studies with 94,181 NAFLD patients (11.3 % with lean NAFLD) and 7,443 fatal events over a median follow-up of 8.4 years (IQR, 6.6-17.4 years) were included. Patients with lean NAFLD had a higher risk of all-cause mortality than those with non-lean NAFLD (random-effects HR 1.61, 95 % CI 1.37-1.89; I2=77 %). The magnitude of this risk remained unchanged even after stratified analysis by measures of NAFLD diagnosis, study country, cohort setting, length of follow-up, adjustment with fibrosis stage/cirrhosis, and the Newcastle-Ottawa Scale. The risk was independent of age, sex, and cardiometabolic risk factors. Sensitivity analyses did not alter these findings. The funnel plot and Egger's test revealed no significant publication bias. CONCLUSIONS: This meta-analysis revealed that lean NAFLD is associated with an approximately 1.6-fold increased mortality risk. Further studies are needed to unravel the existing but complex link between lean NAFLD and an increased risk of death.

Bidirectional association between non-alcoholic fatty liver disease and fatty pancreas: a systematic review and meta-analysis.

BACKGROUND: Accumulating evidence suggests a potential relationship between non-alcoholic fatty liver disease (NAFLD) and fatty pancreas, as both conditions are associated with fat deposition in the liver and pancreas, respectively. The meta-analysis aimed to investigate the bidirectional association between NAFLD and fatty pancreas, as well as their respective effects on disease severity. METHODS: A systematic search of the EMBASE and MEDLINE databases, from inception to August 2022, was conducted to identify observational studies examining the association between NAFLD and fatty pancreas, as well as their impact on disease severity. The pooled odds ratio (OR) with a 95% confidence interval (CI) was estimated using a random-effects model. RESULTS: Our analysis included 26 case-control or cross-sectional studies, comprising 67,803 participants. We observed a significant association between NAFLD and an increased odds of having fatty pancreas (OR, 6.18; 95% CI, 4.49-8.51; I2 = 92%). Similarly, fatty pancreas was significantly associated with an increased odds of having NAFLD (OR, 9.56; 95% CI, 5.09-17.95; I2 = 83%). Furthermore, the presence of fatty pancreas was associated with a 1.75-fold increased risk of severe NAFLD based on ultrasonographic classification (95% CI, 1.46-2.10; I2 = 0%). Among NAFLD patients, the coexistence of fatty pancreas was associated with a trend towards increased odds of having non-alcoholic steatohepatitis (OR, 3.52; 95% CI, 0.65-18.93; I2 = 82%) and advanced fibrosis (OR, 2.47; 95% CI, 0.52-11.80; I2 = 76%). CONCLUSION: This meta-analysis discloses a bidirectional association between NAFLD and fatty pancreas, emphasizing the importance of understanding the intricate relationship between these two conditions.

Reliability and validity study of the Thai adaptation of the Maslach Burnout Inventory-Student Survey among preclinical medical students at a medical school in Thailand.

Burnout syndrome is characterized by emotional exhaustion, cynicism, and lack of professional efficacy. A considerable proportion of medical students experience burnout syndrome during their educational training. Therefore, this issue has become a major concern in the medical education community. The Maslach Burnout Inventory-Student Survey (MBI-SS) is the most widely used assessment of burnout syndrome among college students, including preclinical medical students. Therefore, our objective was to culturally modify and validate the MBI-SS in a Thai context for use with preclinical medical students. The MBI-SS comprises 16 items, including five items for emotional exhaustion, five items for cynicism, and six items for academic efficacy. Four hundred and twenty-six preclinical medical students participated in this study. We randomly divided the samples into two equivalent subsamples of 213 participants. The first subsample was used to calculate McDonald's omega coefficients to assess internal consistency and to perform exploratory factor analysis. McDonald's omega coefficients for exhaustion, cynicism, and academic efficacy were 0.877, 0.844, and 0.846, respectively. The scree plot from the unweighted least squares estimation and a direct oblimin rotation, supplemented with Horn's parallel analysis and the Hull method, revealed three major factors of the Thai MBI-SS. Due to the violation of the multivariate normality assumption in the second subsample, we performed a confirmatory factor analysis with the unweighted least squares with a mean and variance adjusted estimation approach. The results of the confirmatory factor analysis showed favorable goodness-of-fit indices. Data from 187 out of 426 participants (43.9%), who completed a second questionnaire, were utilized to evaluate test-retest reliability. The correlation coefficients for test-retest reliability with a three-week period between tests were 0.724, 0.760, and 0.769 for the exhaustion, cynicism, and academic efficacy domains, respectively (all p < 0.05). This indicates that the Thai MBI-SS is a valid and reliable instrument to assess burnout syndrome in our Thai preclinical medical student population.

The association between irritable bowel syndrome and ischemic colitis: a systematic review and meta-analysis.

INTRODUCTION: Studies have suggested an association between ischemic colitis and irritable bowel syndrome (IBS) although the results were inconsistent. This systematic review and meta-analysis were performed to comprehensively examine the association between IBS and ischemic colitis by identifying all available cohort and case-control studies and combining their effect estimates together. EVIDENCE ACQUISITION: EMBASE, MEDLINE and Google Scholar databases were systematically reviewed up to June 2020. Eligible study had to be either cohort or case-control studies that evaluated whether patients with IBS have a higher risk of ischemic colitis than individuals without IBS. Point estimates and standard errors from each eligible study were combined together using the generic inverse variance method of DerSimonian and Laird. EVIDENCE SYNTHESIS: The systematic review identified three cohort and eight case-control studies. The pooled analysis found a significantly higher risk of ischemic colitis among patient with IBS with the pooled odds ratio of 2.50 (95% CI, 2.00-3.14; I2 57%). Funnel plot was relatively symmetric and was not suggestive of presence of publication bias. CONCLUSIONS: A significantly increased risk of ischemic colitis among patients with IBS was observed in this systematic review and meta-analysis.

Increased prevalence of irritable bowel syndrome in migraine patients: a systematic review and meta-analysis.

OBJECTIVE: Even though evidence showing increased prevalence of irritable bowel syndrome (IBS) among migraine patients exists, it has not been well-established and the magnitude of association varies substantially across the studies. This study aimed to comprehensively compare the prevalence of IBS among migraineurs versus nonmigraineurs using the systematic review and the meta-analysis technique. METHODS: Two authors independently conducted a literature search in MEDLINE, EMBASE and Google Scholar database up to April 2020. The eligible study must consist of two groups of participants, migraineurs and nonmigraineurs, and report the prevalence of IBS in both groups. Alternatively, an eligible study may report the odds ratio (OR) with a 95% confidence interval (CI) of the association between migraine and IBS. Point estimates and standard errors from each eligible study were combined together using the generic inverse variance method of DerSimonian and Laird. RESULTS: Of the 2531 articles identified from the three databases, 11 studies with a total of 28 336 migraineurs and 1 535 758 nonmigraineurs met the selection criteria and were included into the meta-analysis. The pooled analysis found that migraineurs had a significantly higher prevalence of IBS than nonmigraineurs with the pooled OR of 2.49 (95% CI, 2.22-2.78; I2, 42%). The funnel plot was asymmetric and suggested the presence of publication bias. CONCLUSION: A significantly increased prevalence of IBS among patients with migraine was demonstrated in this study.

Reliability and validity study of the Thai adaptation of the Copenhagen Burnout Inventory-Student Survey (CBI-SS) among preclinical medical students at the Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand.

Burnout syndrome is a syndrome of emotional exhaustion, professional efficacy and cynicism. A significant proportion of medical students reported having burnout syndrome during their training in medical education. Several tools including the Copenhagen Burnout Inventory-Student Survey (CBI-SS) are considered to be a valid measurement of burnout syndrome in medical students. This study aimed to translate, culturally adapt, and validate the CBI-SS for assessing burnout syndrome among preclinical medical students in Thailand. This study was conducted during February to March 2019 at the Faculty of Medicine Siriraj Hospital, Mahidol University (Bangkok, Thailand), which is Thailand's largest and oldest medical school, and Thailand's largest national tertiary referral center. After receiving formal permission to do so from the copyright owner, the original English language version of the CBI-SS was translated to Thai language using an internationally recommended and accepted forward-backward translation protocol. The Thai version of the CBI-SS (Thai CBI-SS) comprises 25 items, including 6 items for personal burnout, 7 items for study-related burnout, 6 items for colleague-related burnout, and 6 items for teacher-related burnout. Standardized Cronbach's alpha coefficient was calculated to evaluate internal consistency reliability, and correlation coefficient was computed to determine test-retest reliability. A total of 414 preclinical medical students participated in this study. Due to sub-optimal factor weights (<0.50), items 6, 10 and 17 were excluded. The Cronbach's alpha coefficients of the 22-item Thai CBI-SS for personal, study-related, colleague-related, and teacher-related burnout were 0.898, 0.896, 0.910 and 0.900 respectively. The correlation coefficients for test-retest reliability after three weeks were 0.820, 0.870, 0.821, and 0.787 for personal, study-related, colleague-related, and teacher-related burnout, respectively. Maximum likelihood analysis with oblimin rotation indicated four main components, and confirmatory factor analysis revealed good fit indices of the Thai CBI-SS. Confirmatory factor analysis showed good fit indices of CBI-SS domains (χ2/df = 2.39; CFI = 0.957; GFI = 0.909; RMSEA = 0.058; TLI = 0.949; and NFI = 0.928). The convergent validity analysis using the Average Variance Extracted (AVE) and the Composite Reliability (CR) was adequate for all dimensions (personal: AVE = 0.626, CR = 0.893; study-related: AVE = 0.601, CR = 0.899; colleague-related: AVE = 0.677, CR = 0.913; teacher-related: AVE = 0.606, CR = 0.900). The HTMT values for all variables are in the range from 0.315 to 0.833, confirming the discriminant validity. The Thai CBI-SS was found to be a valid and reliable tool for evaluating burnout syndrome in preclinical medical students in Thailand.

The Effects of Modest Alcohol Consumption on Non-alcoholic Fatty Liver Disease: A Systematic Review and Meta-Analysis.

Background and Objective: There is no consensus regarding modest alcohol consumption in patients with non-alcoholic fatty liver disease (NAFLD) due to conflicting results. The aim of this meta-analysis was to examine the effects of modest alcohol consumption on histological severity, histological course, hepatocellular carcinoma, and long-term clinical outcomes in NAFLD patients. Methods: We searched MEDLINE and EMBASE databases from inception to October 2020 for studies evaluating the effects of modest alcohol consumption among patients with NAFLD. A random-effects meta-analysis using pooled odds ratio (OR) and hazard ratio (HR) was calculated with 95% confidence interval (CI). Study quality was assessed with the Newcastle-Ottawa Scale. Results: Fourteen cross-sectional or cohort studies with aggregate data on 14,435 patients were included in the analysis. Modest alcohol consumption resulted in lower risks for steatohepatitis (OR 0.59; 95% CI 0.45-0.78; I 2 = 12%) and advanced fibrosis (OR 0.59, 95% CI 0.36-0.95; I 2 = 75%). Histological follow-up data showed that modest alcohol use was associated significantly with less steatohepatitis resolution but not with fibrosis progression. The HR for developing hepatocellular carcinoma was 3.77 (95% CI 1.75-8.15; I 2 = 0%). NAFLD patients with modest alcohol intake had a lower mortality risk than lifelong abstainers (HR 0.85; 95% CI 0.75-0.95; I 2 = 64%). Conclusion: This meta-analysis suggests that medical advice for modest alcohol drinking should be made cautiously in caring for an individual patient based on the clinical context. Practically, patients with steatohepatitis or advanced fibrosis should avoid alcohol use, whereas patients with low fibrosis risk may be allowed for modest and safe drinking.

Hepatitis B virus infection and risk of gastric cancer: a systematic review and meta-analysis.

INTRODUCTION: Hepatitis B virus (HBV) infection is a well-established risk factor for hepatocellular carcinoma. Recent studies have also suggested a higher risk of several extrahepatic cancers in patients with chronic HBV infection, including gastric cancer, even though the results are somewhat inconsistent. The current study was conducted to comprehensively investigate whether patients with HBV infection are at a higher risk of incident gastric cancer compared with individuals without HBV infection using systematic review and meta-analysis technique. EVIDENCE ACQUISITION: Systemic literature review was conducted using EMBASE and MEDLINE database up to December 2019. Eligible studies had to be cohort studies that consisted of one group of patients with HBV infection and another group of individuals without HBV infection. Relative risk of incident gastric cancer between the groups must be reported. Point estimates and standard errors from each eligible study were combined together using the generic inverse variance method of DerSimonian and Laird. EVIDENCE SYNTHESIS: A total of 36,812 articles were identified. After two rounds of review, five articles with six cohorts of 120,995 HBV infected patients were included into the meta-analysis. The pooled analysis found that patients with HBV infection had a significantly higher risk of incident gastric cancer than individuals without HBV infection with the pooled risk ratio of 1.49 (95% CI, 1.20 - 1.85; I2=38%). CONCLUSIONS: A significantly increased risk of incident gastric cancer among patients with chronic HBV infection was observed in this systematic review and meta-analysis.

The correlation between heart failure and the risk of ischemic colitis: a systematic review and meta-analysis.

BACKGROUND: Ischemic colitis is a relatively common gastrointestinal disease caused by hypoperfusion of the colon. Recently, studies have suggested an association between heart failure (HF) and ischemic colitis, even though the magnitude of the reported association varied considerably across the studies. This systematic review and meta-analysis were performed to comprehensively explore whether patients with HF are at a higher risk of ischemic colitis compared with individuals without HF by combining the results of all available observational studies. METHODS: Systematic literature review was performed using EMBASE, MEDLINE and Google Scholar database up to May 2020. Eligible studies could be any observational ones that evaluated whether patients with HF have a higher risk of ischemic colitis than individuals without HF. Point estimates and standard errors from each eligible study were combined together using the generic inverse variance method of DerSimonian and Laird. RESULTS: The systematic review identified 7 case-control studies and 1 cross-sectional study. The pooled analysis found that patients with HF had a significantly higher risk of ischemic colitis with the pooled odds ratio of 3.42 (95% confidence interval 1.49-7.82; I2 96%). Funnel plot was relatively symmetric and was not suggestive of presence of publication bias. CONCLUSION: A significantly increased risk of ischemic colitis among patients with HF was demonstrated in this systematic review and meta-analysis.

Patients with asthma have a higher risk of systemic lupus erythematosus: a systematic review and meta-analysis.

OBJECTIVE: This study aimed to investigate the association between asthma and risk of systemic lupus erythematosus (SLE) using systematic review and meta-analysis technique. METHODS: Potentially eligible studies were identified from Medline and EMBASE databases from inception to March 2020 using search strategy that comprised of terms for "asthma" and "systemic lupus erythematosus." Qualified cohort study must consist of one cohort of patients with asthma and another cohort of individuals without asthma. Then, the study must report relative risk (RR) with 95% confidence intervals (95% CIs) of incident SLE between the two groups. Qualified case-control studies must consist of cases with SLE and controls without SLE. Then, the study must explore their history of asthma. Odds ratio (OR) with 95% CIs of the association between asthma status and SLE must be reported. Point estimates and standard errors were extracted from each study and were combined using the generic inverse variance method. RESULTS: A total of 21,486 articles were identified. After two rounds of independent review by three investigators, three cohort studies and seven case-control studies met the eligibility criteria and were included into the meta-analysis. Patients with asthma had a significantly higher risk of SLE compared with individuals without asthma with the pooled odds ratio of 1.37 (95% CI 1.14-1.65; I2 67%). Funnel plot was symmetric and did not suggest the presence of publication bias. CONCLUSIONS: The current study found a significant association between asthma and increased risk of SLE. Key Points • Studies have suggested an elevated risk of systemic lupus erythematosus among patients with asthma; however, the results from existing studies are inconsistent. • This meta-analysis included data from three cohort studies and seven case--control studies. • A significant association between asthma and elevated risk of systemic lupus erythematosus was observed, with the pooled odds ratio of 1.37 (95% CI 1.14-1.65; I2 67%).

Allergic rhinitis and risk of systemic lupus erythematosus: A systematic review and meta-analysis.

OBJECTIVE: The current study was conducted to comprehensively investigate whether patients with allergic rhinitis (AR) are at a higher risk of incident systemic lupus erythematosus (SLE) compared with individuals without AR by using systematic review and meta-analysis techniques to combine data from all available studies. METHODOLOGY: Systemic literature review was performed using EMBASE and MEDLINE databases up to March 2020. Eligible studies could be either case-control or cohort studies. Cohort studies had to evaluate whether patients with AR have a higher risk of incident SLE than comparators. Relative risk (RR) with associated 95% confidence intervals (CI) comparing the incidence of SLE between participants with and without AR had to be provided. Eligible case-control studies had to provide odds ratio (OR) with 95% CI comparing the prevalence of AR between cases with SLE and controls without SLE. Point estimates and standard errors from each eligible study were combined together using the generic inverse variance method of DerSimonian and Laird. RESULTS: A total of 21 486 articles were retrieved. After 2 rounds of review, 1 cohort study and 7 case-control studies with 3 326 171 participants were included into the meta-analysis. The pooled analysis found that patients with AR had a significantly higher risk of SLE than individuals without AR with the pooled OR of 1.36 (95% CI 1.08-1.72; I2 of 80%). CONCLUSIONS: A significantly increased 1.4 fold risk of SLE among patients with AR was observed in this systematic review and meta-analysis.

Tuberculosis and risk of coronary heart disease: A systematic review and meta-analysis.

BACKGROUND: Increased risk of coronary heart disease has been observed in several chronic inflammatory disorders, including chronic infection. However, data on the association between tuberculosis and risk of coronary heart disease are limited. METHODOLOGY: This systematic review and meta-analysis identified all cohort studies that compared the risk of coronary heart disease among patients with tuberculosis versus individuals without tuberculosis and summarized their results together. Literature search was independently conducted by two investigators using MEDLINE and EMBASE database up to August 2019. Point estimates and standard errors from each study were pooled together using the generic inverse variance method of DerSimonian and Laird. RESULTS: A total of four cohort studies met the eligibility criteria and were included into the meta-analysis. The pooled analysis found that patients with tuberculosis have an increased risk of developing coronary heart disease with the pooled risk ratio of 1.76 (95% CI, 1.05-2.95; I2 of 97%). CONCLUSION: A significantly increased risk of coronary heart disease among patients with tuberculosis was demonstrated by the current study.

Use of proton pump inhibitors is associated with a higher risk of pneumonia in cirrhotic patients: a systematic review and meta-analysis.

BACKGROUND: Proton pump inhibitors (PPIs) are commonly prescribed for cirrhotic patients. However, the use of PPIs in these patients may increase the risk of bacterial infection. The current study aimed to investigate the risk of developing pneumonia among cirrhotic patients exposed to PPIs. METHODS: A literature search was independently conducted by 2 investigators using the MEDLINE and EMBASE databases up to September 2019. To be eligible, a study had to be an observational (cohort, case-control or cross-sectional) study that included one group of cirrhotic patients with PPI use and another group of cirrhotic patients without PPI use. Effect estimates of the association between PPI use and pneumonia had to be reported. Point estimates and standard errors from each eligible study were combined together using the generic inverse variance method of DerSimonian and Laird. RESULTS: Of 1947 articles identified from the 2 databases, 3 cohort and 5 cross-sectional studies with 40,295 participants met the eligibility criteria and were included in the meta-analysis. The pooled analysis found that cirrhotic patients with a history of PPI use had a significantly higher risk of developing pneumonia than those without PPI use, with a pooled risk ratio of 1.36 (95% confidence interval 1.00-1.85; I 2 47%). CONCLUSION: A significantly increased risk of pneumonia among cirrhotic patients exposed to PPIs was demonstrated in this study.

Effects of Live Lecture Attendance on the Academic Achievement of Preclinical Medical Students.

BACKGROUND: Live lecture remains a ubiquitous form of knowledge delivery in preclinical medical education. However, voluntary live lecture attendance has markedly decreased at several medical schools. This case-control study examined the effect of live lecture attendance on academic achievement in selected basic science courses. METHODS: Cases (n = 174) were defined as students with below average examination scores, and controls (n = 198) were defined as students with above average examination scores. The exposure was absenteeism, which was defined as attending live lecture less than 75% of total live lecture sessions. Second-year and third-year students reported self-estimated frequency regarding live lecture attendance, and they estimated the time spent engaged in various behaviors during live lectures. RESULTS: Absenteeism was identified as a significant risk factor for having below average score in preclinical medical science courses with a 2.34-fold risk (95% confidence interval [CI]: 1.27-4.33). Distracting behavior more than 25% of live lecture time was a factor with non-significantly increased risk for having below average score (1.36-fold risk, 95% CI: 0.86-2.13). CONCLUSIONS: Absenteeism was compellingly associated with poorer examination performance among medical students in basic science medical courses. Preclinical medical students should be encouraged to attend live lectures as often as possible.