Adequacy and quality of abdominal echographies requested by primary care professionals.

BACKGROUND: The value of abdominal echography in primary care is great because it is innocuous, inexpensive, easy to perform and provides a great deal of information making this the first examination to be requested in cases of probable abdominal disease. However, too many abdominal echographies are probably requested overcrowding the Departments of Radiodiagnosis with not always justified petitions or with repetition of tests based on little clinical criteria. METHODS/DESIGN: The aim of the study is to evaluate the adequacy and quality of abdominal echographies requested by primary care physicians in the Maresme County (North of Barcelona), develop guidelines for indicating echographies and reevaluate this adequacy after implementing these guidelines.We will perform a two-phase study: the first descriptive, and retrospective evaluating the adequacy and quality of petitions for abdominal echographies, and in the second phase we will evaluate the impact of recommendations for indicating abdominal echographies for PC physicians on the adequacy and quality of echography petitions thereafter.This study will be carried out in 10 primary care centres in the Maresme (Barcelona).1067 abdominal echographies requested by primary care physicians from the above mentioned centres from January 2007 to April 2010 and referred to the Department of Radiology and the same number of applications after the intervention.All the petitions for abdominal echographies requested will be analysed and the clinical histories will be obtained to determine demographic variables, the reason for the visit and for the echography petition and diagnostic orientation, clinical and echographic data, evaluation of the echographies according to the quality and variables characterising the professionals requesting the echographies including: age, sex, laboral situation, length of time in work post, formation, etc.To achieve a consensus of the adequacy of abdominal echography, a work group including gastroenterologists, radiologists and general practitioners will be created following the nominal group. This will allow the design of guidelines for the indication of abdominal echography and posterior evaluation of their impact among physicians by diffusion and posterior reevaluation of the adequacy of the petitions.

Risk factors associated with non-alcoholic fatty liver disease in subjects from primary care units. A case-control study.

BACKGROUND: Non alcoholic fatty liver disease (NAFL) consists in the accumulation of fat vacuoles in the cytoplasm of hepatocytes. Many etiologic factors are associated with NAFL, such as, the metabolic syndrome factors, medications, bariatric surgery, nutritional disorders. However, very little information is available on the clinical relevance of this disorder as a health problem in the general population. METHODS AND DESIGN: The aim of the study is establish the risk factors most frequently associated with NAFL in a general adult population assigned to the primary care units and to investigate the relationship between each component of the metabolic syndrome and the risk of having a NAFL. A population based case-control, observational and multicenter study will be carried out in 18 primary care units from the "Area de Gestión del Barcelonés Nord y Maresme" (Barcelona) attending a population of 360,000 inhabitants and will include 326 cases and 370 controls. Cases are defined as all subjects fulfilling the inclusion criteria and with evidence of fatty liver in an abdominal ultrasonography performed for any reason. One control will be randomly selected for each case from the population, matched for age, gender and primary care center. Controls with fatty liver or other liver diseases will be excluded. All cases and controls will be asked about previous hepatic diseases, consumption of alcohol, smoking and drugs, and a physical examination, biochemical analyses including liver function tests, the different components of the metabolic syndrome and the HAIR score will also be performed. Paired controls will also undergo an abdominal ultrasonography. DISCUSSION: This study will attempt to determine the factors most frequently associated with the presence of NAFL investigate the relationship between the metabolic syndrome and the risk of fatty liver and study the influence of the different primary care professionals in avoiding the evolution of the disease.

Prevalence and factors associated with the presence of non alcoholic fatty liver disease in an apparently healthy adult population in primary care units.

BACKGROUND: Fatty liver disease is characterized by the accumulation of fat vacuoles inside of the hepatocytes. Non alcoholic fatty liver is associated with obesity, type 2 diabetes, dyslipemia, the intake of certain drugs and with the so-called metabolic syndrome. However, there is little information on the clinical relevance of this disorder as a healthcare problem in the general population, since the studies published generally include a limited number of patients and the diagnosis is established on the basis of clear biochemical alterations and liver biopsy. METHODS/DESIGN: The aim of the study is the prevalence of non-alcoholic fatty liver disease in a general adult population by hepatic ultrasonography.A population-based, descriptive, transversal, multicentre study. Eighteen primary care centres of the north of Barcelona and the Maresme Areas of Healthcare Management attending an urban and semi-urban population of 360.000 inhabitants.A randomized sample of 786 subjects of 15 years or older were selected from the population and assigned to the participating centres according to the Primary Care Information System (SIAP): This population is practically the same as the general population of the area. The following determinations will be carried out in all the participants: hepatic ultrasonography to detect fatty liver, a questionnaire concerning liver diseases, alcohol intake, smoking and drug use, physical examination including abdominal perimeter and body mass index and biochemical analysis including liver function tests and parameters related to the metabolic syndrome and the HAIR score. Ultrasonographic diagnosis of fatty liver will be made according to established criteria (American Gastroenterology Association) and diagnosis of metabolic syndrome according to the criteria of the European Group for the Study of Insulin Resistance. DISCUSSION: This study will attempt to determine the prevalence of non alcoholic fatty liver disease, as well as, the factors most frequently associated with the presence of this disease to thereby achieve the most appropriate treatment and avoid the evolution of the disease.

Metabolic syndrome and nonalcoholic fatty liver disease in a Spanish population: influence of the diagnostic criteria used.

OBJECTIVE: Nonalcoholic fatty liver disease (NAFLD) is highly prevalent and it is considered the hepatic component of the metabolic syndrome (MetS). The WHO, the National Cholesterol Education Program (NCEP) and the International Diabetes Federation (IDF) have different criteria to define MetS. The aim of this study was to analyze the association between NAFLD and MetS using the three existing criteria. METHODS: Cross-sectional, descriptive population-based study derived from a previous study on the prevalence and factors associated with NAFLD in Spain. RESULTS: A total of 696 individuals [mean age 53 ± 14 years (range 17-83 years)] were included, 59% of whom were women. The prevalence of MetS was 34.2% according to the IDF, 17.7% according to the NCEP and 15.5% according to the WHO. Concordance among the different criteria was between 76 and 87%, with kappa indexes between 0.39 and 0.54. NAFLD was present in 184 individuals according to echographic criteria (prevalence 26.4%). The prevalence of NAFLD among patients with MetS was 43% (IDF), 53% (NCEP) and 64% (WHO). The odds ratio (95% confidence interval) for a logistic regression using NAFLD as a dependent variable varied from 3.44 (2.42-4.88) for IDF to 7.28 (4.68-11.3) for WHO, being 4.28 (2.84-6.43) for NCEP. CONCLUSION: The MetS is quite frequent in the general population, although its prevalence varies considerably according to the criteria used for its definition. The MetS is associated with NAFLD, with the WHO definition being the best to determine its presence, probably because of the inclusion of insulin resistance as a main component. Unification of criteria is needed to adequately compare the prevalence of MetS and its relationship with NAFLD in different population groups.

Prevalence and factors associated with the presence of nonalcoholic fatty liver disease in an adult population in Spain.

BACKGROUND/AIMS: The prevalence of nonalcoholic fatty liver disease (NAFLD) is unknown in Spain. The purpose of detecting NAFLD patients is to determine the associated factors and prevent its evolution to more severe forms. The aim of this study is to determine the prevalence and factors associated with NAFLD. METHODS: This is a multicentre, cross-sectional, populational study. Individuals between 15 and 85 years of age were randomly selected from 25 primary healthcare centres in the province of Barcelona, Spain. Clinical histories were reviewed, and anamnesis, physical examination, blood analysis and hepatic echography were performed. Individuals with an alcohol intake greater than 30 g/day in men and greater than 20 g/day in women or with known liver disease were excluded. RESULTS: Seven hundred and sixty-six individuals with a mean age of 53+/-14 years (range 17-83, 42.2% men) were included in the study. One hundred and ninety-eight individuals presented NAFLD with echographic criteria (prevalence 25.8, 33.4% men and 20.3% women P<0.001). On multivariate analysis, the following were associated with NAFLD: male sex [odds ratio (OR): 2.34, 95% confidence interval (95% CI): 1.57-3.49], age (OR: 1.04 per year, 95% CI: 1.02-1.05), metabolic syndrome (OR: 2.19, 95% CI: 1.29-3.72), insulin resistance (OR: 6.00, 95% CI: 3.43-10.5) and alanine aminotransferase (OR: 4.21, 95% CI: 2.23-7.95). Of the individuals who consumed alcohol, 29.4% consumed alcohol within the inclusion criteria, with a mean of 9.17+/-6.75 standard beverage units per week. Moderate alcohol intake was not related to NAFLD, although a possible protector effect was found with the quantity consumed among the drinkers who did not consume excessive amounts of alcohol (OR: 0.93 per standard beverage units, 95% CI: 0.88-0.98). CONCLUSION: NAFLD prevalence in our population is very high. Male sex, age, metabolic syndrome, insulin resistance and alanine aminotransferase are the factors associated with NAFLD. Furthermore, studies should be carried out with respect to the controversial effect of alcohol on NAFLD.