Prevalence of Early Chronic Kidney Disease and Main Associated Factors in Spanish Population: Populational Study.

The aim of this study was to determine the prevalence of early chronic kidney disease (EKD) (stages 1 and 2) and the factors associated. This was a populational study including individuals from 18-75 years randomly selected from 18 Primary Healthcare centers in the area of Barcelonès Nord and Maresme (Catalunya, Spain). Variables: anamnesis, physical examination, blood pressure, and analysis. EKD was defined with by a glomerular filtration rate (GFR) ≥60 mL/min/1.73 m2 and albumin/creatinine ratio (ACR) ≥17 mg/g in men and ≥25 mg/g in women confirmed with two determinations. 2871 individuals: 43% men, mean age 55 years (19-75), 32.2% obese, 50.5% abdominal obesity, 21.1% hypertensive, and 10.6% diabetic. Prevalence of EKD: With one determination 157 individuals (5.5%), 110 men (9%) and 47 women (2.8%); with two determinations 109 individuals (3.8%), 85 men (7%), and 24 women (1.5%). Factors independently associated with the multivariate logistic regression model: Man (OR 3.35), blood pressure ≥ 135/85 mmHg (OR 2.29), BMI ≥ 30 kg/m2 (OR 2.48), glycemia ≥ 100 mg/dL (OR 1.73), smoker (OR 1.67) and age (OR 1.04). The prevalence varies if the diagnosis is established based on one or two analytical determinations, overestimated if only one determination is made and depends on the value chosen to define urine albumin excretion.

High Prevalence of Liver Fibrosis Among European Adults With Unknown Liver Disease: A Population-Based Study.

BACKGROUND & AIMS: Liver fibrosis is the main determinant of long-term outcome in chronic liver diseases. Little is known about the prevalence of liver fibrosis in the general population. The aim of the study was to investigate the prevalence of liver fibrosis in the general adult population with unknown liver disease. METHODS: This was a population-based, cross-sectional study performed in the Barcelona metropolitan area. Subjects aged 18 to 75 years old were identified randomly from citizens included in the primary health care registry. Of 4866 subjects invited, 3076 participated (63.2%). Liver fibrosis was estimated by measuring liver stiffness (LS) with transient elastography (TE). Liver histology was assessed in 92 subjects with increased LS. RESULTS: Prevalence estimates of increased LS (≥6.8, ≥8.0, and ≥9.0 kPa) were 9.0%, 5.8%, and 3.6%, respectively. The etiology of liver disease was mainly nonalcoholic fatty liver disease (NAFLD), followed by alcohol risk consumption (consumption of ≥21 standard drinking units/wk in men and ≥14 standard drinking units/wk in women). Factors independently associated with increased LS were male sex, abdominal obesity, type 2 diabetes, serum glucose, high-density lipoprotein, and triglyceride levels. Subjects without risk factors for NAFLD or without alcohol risk consumption had a very low prevalence of increased LS. The best cut-off value of LS for significant liver fibrosis (F2-F4) was 9.2 kPa, with high sensitivity and specificity. TE was more accurate than alanine aminotransferase, NAFLD fibrosis score, or Fibrosis 4. An algorithm for screening for liver fibrosis using TE in the community setting is proposed. CONCLUSIONS: These findings show a high prevalence of silent liver disease with advanced fibrosis mainly related to NAFLD in adult European subjects without known liver disease. An LS value less than 9.2 kPa predicts the absence of significant liver fibrosis with high accuracy and could be used for screening purposes.

Marcadores no invasivos de fibrosis en el diagnóstico del hígado graso no alcohólico / Non-invasive markers of fibrosis in the diagnosis of non-alcoholic fatty liver disease

OBJETIVO: Analizar la utilidad de tres índices predictivos de fibrosis en la detección de hígado graso no alcohólico (HGNA) como método no invasivo en atención primaria. Diseño Estudio descriptivo de base poblacional, multicéntrico y transversal, procedentes de 25 Centros de Atención Primaria de la provincia de Barcelona. Participantes Individuos sanos entre 17-83 años seleccionados aleatoriamente a partir del Sistema Informático de Atención Primaria (SIAP).Método Anamnesis, exploración física, analítica para determinar los índices predictivos de fibrosis; HAIR (hipertensión arterial, resistencia a insulina, alaninaaminotransferas a); Fatty Liver Index (FLI) (índice de masa corporal, gammaglutamiltranspeptidasa, triglicéridos, perímetro abdominal) y Lipid Accumulation Product (LAP) (triglicéridos, perímetro abdominal), y ecografía abdominal. RESULTADOS: Setecientos dos individuos, 58% mujeres, edad media de 53±14 años. Un 30,8% tuvieron FLI positivo, 6,7% el HAIR y 15,5% el LAP, oscilando la concordancia entre los tres índices entre el 63,1% y el 84,9%, con índices kappa entre 0,18 y 0,50. Cumplían criterios ecográficos de HGNA 184 individuos representando una prevalencia de 26,29%. La prevalencia de HGNA en pacientes con índice FLI, HAIR y LAP positivo fue del 46,8%, 68,1% y 56,0% respectivamente. El índice con mayor sensibilidad para HGNA fue el FLI ≥ 60 con un 84%. La especificidad fue mayor para el HAIR y LAP con un 97% y 91% respectivamente. CONCLUSIONES: FLI, HAIR y LAP son muy prevalentes y se han mostrado como marcadores independientes para el diagnóstico de HGNA. La falta de concordancia entre estos índices, provoca la obtención de diferentes prevalencias siendo necesario unificar criterios para obtener un índice más útil para el diagnóstico de HGNA

OBJECTIVE: To analyze the utility of three indices to predict hepatic fibrosis in the detection of non-alcoholic fatty liver disease (NAFLD) as a non-invasive method in primary care. DESIGN: We performed a descriptive, cross-sectional, multicenter study with a populational base from 25 primary care centers in the province of Barcelona. PARTICIPANTS: Healthy individuals aged 17 to 83 years randomly selected from the Primary Care Computer System. METHODS: Medical history, physical examination, and blood analyses were used to determine the following predictive indices of fibrosis; HAIR (hypertension, alanine-aminotransferase, insulin resistance); Fatty Liver Index (FLI) (body mass index, gammaglutamyl-transpeptidase, triglycerides, abdominal perimeter) and Lipid Accumulation Product (LAP) (triglycerides, abdominal perimeter), and abdominal echography. RESULTS: We included 702 individuals; 58% were women and the mean age was 53±14 years. The FLI was positive in 30.8%, HAIR was positive in 6.7%, and LAP was positive in 15.5%. Agreement among the three indices ranged from 63.1% to 84.9%, with kappa indices between 0.18 and 0.50. A total of 184 individuals met the echographic criteria of NAFLD, representing a prevalence of 26.29%. The prevalence of NAFLD in patients with positive FLI, HAIR and LAP indices was 46.8%, 68.1% and 56%, respectively. The index with the greatest sensitivity for NAFLD was tFLI≥60 with 84%. Specificity was highest for HAIR and LAP with 97% and 91%, respectively. CONCLUSIONS: FLI, HAIR and LAP are highly prevalent and have been shown to be independent markers for the diagnosis of NAFLD. Because of the lack of concordance between the indices, different prevalences are obtained, thus requiring criteria to be unified in order to obtain a more useful index for the diagnosis of NAFLD. Because of the lack of concordance between the indices, different prevalences are obtained, thus requiring criteria to be unified in order to obtain a more useful index for the diagnosis of NAFLD

[Non-invasive markers of fibrosis in the diagnosis of non-alcoholic fatty liver disease]. / Marcadores no invasivos de fibrosis en el diagnóstico del hígado graso no alcohólico.

OBJECTIVE: To analyze the utility of three indices to predict hepatic fibrosis in the detection of non-alcoholic fatty liver disease (NAFLD) as a non-invasive method in primary care. DESIGN: We performed a descriptive, cross-sectional, multicenter study with a populational base from 25 primary care centers in the province of Barcelona. PARTICIPANTS: Healthy individuals aged 17 to 83 years randomly selected from the Primary Care Computer System. METHODS: Medical history, physical examination, and blood analyses were used to determine the following predictive indices of fibrosis; HAIR (hypertension, alanine-aminotransferase, insulin resistance); Fatty Liver Index (FLI) (body mass index, gammaglutamyl-transpeptidase, triglycerides, abdominal perimeter) and Lipid Accumulation Product (LAP) (triglycerides, abdominal perimeter), and abdominal echography. RESULTS: We included 702 individuals; 58% were women and the mean age was 53±14 years. The FLI was positive in 30.8%, HAIR was positive in 6.7%, and LAP was positive in 15.5%. Agreement among the three indices ranged from 63.1% to 84.9%, with kappa indices between 0.18 and 0.50. A total of 184 individuals met the echographic criteria of NAFLD, representing a prevalence of 26.29%. The prevalence of NAFLD in patients with positive FLI, HAIR and LAP indices was 46.8%, 68.1% and 56%, respectively. The index with the greatest sensitivity for NAFLD was tFLI≥60 with 84%. Specificity was highest for HAIR and LAP with 97% and 91%, respectively. CONCLUSIONS: FLI, HAIR and LAP are highly prevalent and have been shown to be independent markers for the diagnosis of NAFLD. Because of the lack of concordance between the indices, different prevalences are obtained, thus requiring criteria to be unified in order to obtain a more useful index for the diagnosis of NAFLD.

Factores de riesgo asociados a la presencia de hígado graso no alcohólico: un estudio de casos y controles / Risk factors associated with non-alcoholic fatty liver disease: A case-control study

Fundamento y objetivos: Establecer los factores asociados a la presencia de hígado graso no alcohólico (HGNA) y evaluar la influencia de cada uno de los componentes que forman el síndrome metabólico (SM) y el riesgo de padecer HGNA. Pacientes y método: Estudio analítico observacional de casos y controles, multicéntrico y de base poblacional. Se define como caso todos aquellos pacientes que cumplan los criterios de inclusión y presenten un HGNA mediante la práctica de una ecografía abdominal realizada por cualquier motivo. Para cada caso se selecciona un control al azar del mismo centro de salud, de la misma edad y sexo. A todos los casos se les realizó una anamnesis, exploración física, analítica completa y la determinación del SM según los criterios del National Cholesterol Education Program-Adult Treatment Panel III. A los controles se les practicó además una ecografía abdominal. Resultados:Se incluyeron 327 casos y 377 controles. La edad media (DE) fue de 56 (12) años en los casos y de 55 (13) años en los controles (extremos 17-80 años). El porcentaje de varones en los grupos de casos y controles, fue del 52,0 y 49,1%, respectivamente. Los factores de riesgo asociados a HGNA fueron la obesidad (odds ratio [OR] 3,82, intervalo de confianza del 95% [IC 95%] 2,19-6,66), SM (OR 1,73, IC 95% 1,09-2,75), resistencia a la insulina (OR 3,65, IC 95% 2,18-6,12), aumento de la alanino aminotransferasa (ALT) (OR 4,72, IC 95% 2,58-8,61) y gamma glutamil transferasa (GGT) (OR 1,95, IC 95% 1,14-3,34). Los componentes del SM que predicen mejor el HGNA fueron la hiperglucemia (OR 1,65, IC 95% 1,06-2,56) y los triglicéridos (OR 1,75, IC 95% 1,13-2,72). Conclusiones: Las variables independientes asociadas a HGNA son la obesidad, la resistencia a la insulina y valores de ALT y GGT elevados. Los componentes del SM que mejor predicen el HGNA son la hiperglucemia y el aumento de los triglicéridos (AU)

Background and objectives: To establish the factors associated with the presence of non-alcoholic fatty liver disease (NAFLD) and evaluate the influence of each component constituting the metabolic syndrome (MS) and the risk of developing NAFLD. Patients and methods: We performed a multicenter, population-based, observational, analytical study of cases and controls. A case was defined as any patient fulfilling the inclusion criteria and presenting NAFLD by abdominal echography for any reason. A control was randomly selected for each case, from the same health center and of the same age and sex. All the cases underwent anamnesis, physical examination, complete biochemical analyses and determination of MS according to the National Cholesterol Education Program-Adult Treatment Panel III criteria. All the controls also underwent an abdominal echography. Results: We included 327 cases and 377 controls with a mean age of 56 ± 12 years for the cases and of 55 ± 13 years for the controls (range: 17 and 80 years); 52.0% of the cases were males and 49.1% of males were controls. The risk factors associated with NAFLD were obesity (odds ratio [OR] 3.82, 95% confidence interval [95% CI] 2.19-6.66), MS (OR 1.73, 95% CI 1.09-2.75), insulin resistance (OR 3.65, 95% CI 2.18-6.12), and an increase in alanine aminotransferase (ALT) (OR 4.72, 95% CI 2.58-8.61) and gamma glutamyl transferase values (GGT) (OR 1.95, 95% CI 1.14-3.34). The components of the MS best predicting NAFLD were hyperglycemia (OR 1.65, 95% CI1.06-2.56) and triglyceride values (OR 1.75, 95% CI1.13-2.72). Conclusions: The independent variables associated with NAFLD were obesity, insulin resistance and elevated ALT and GGT. The components of MS best predicting NAFLD were hyperglycemia and an increase in triglyceride values (AU)

[Risk factors associated with non-alcoholic fatty liver disease: a case-control study]. / Factores de riesgo asociados a la presencia de hígado graso no alcohólico: un estudio de casos y controles.

BACKGROUND AND OBJECTIVES: To establish the factors associated with the presence of non-alcoholic fatty liver disease (NAFLD) and evaluate the influence of each component constituting the metabolic syndrome (MS) and the risk of developing NAFLD. PATIENTS AND METHODS: We performed a multicenter, population-based, observational, analytical study of cases and controls. A case was defined as any patient fulfilling the inclusion criteria and presenting NAFLD by abdominal echography for any reason. A control was randomly selected for each case, from the same health center and of the same age and sex. All the cases underwent anamnesis, physical examination, complete biochemical analyses and determination of MS according to the National Cholesterol Education Program-Adult Treatment Panel III criteria. All the controls also underwent an abdominal echography. RESULTS: We included 327 cases and 377 controls with a mean age of 56 ± 12 years for the cases and of 55 ± 13 years for the controls (range: 17 and 80 years); 52.0% of the cases were males and 49.1% of males were controls. The risk factors associated with NAFLD were obesity (odds ratio [OR] 3.82, 95% confidence interval [95% CI] 2.19-6.66), MS (OR 1.73, 95% CI 1.09-2.75), insulin resistance (OR 3.65, 95% CI 2.18-6.12), and an increase in alanine aminotransferase (ALT) (OR 4.72, 95% CI 2.58-8.61) and gamma glutamyl transferase values (GGT) (OR 1.95, 95% CI 1.14-3.34). The components of the MS best predicting NAFLD were hyperglycemia (OR 1.65, 95% CI1.06-2.56) and triglyceride values (OR 1.75, 95% CI1.13-2.72). CONCLUSIONS: The independent variables associated with NAFLD were obesity, insulin resistance and elevated ALT and GGT. The components of MS best predicting NAFLD were hyperglycemia and an increase in triglyceride values.

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.

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.