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1.
Top Antivir Med ; 27(3): 101-110, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31634861

RESUMO

Among individuals with HIV infection, liver disease remains an important cause of morbidity and mortality, even with the availability of agents that cure hepatitis C infection and suppress hepatitis B replication. The causes of liver disease are multifaceted and continue to evolve as the population ages and new etiologies arise. Nonalcoholic fatty liver disease and nonalcoholic steatohepatitis and hepatitis viruses such as A, D, and E have emerged even as hepatitis C has receded. Newer antiretroviral agents may increase risk of weight gain and subsequent fatty infiltration, and prior use of nucleotide-based therapies may continue to impact liver health. Several barriers including economics, social stigma, and psychiatric disease impact identification of liver disease, as well as management and treatment interventions. Hepatocellular carcinoma is emerging as a more common and late-diagnosed complication in those with HIV infection and liver disease.


Assuntos
Infecções por HIV/complicações , Hepatite Viral Humana/complicações , Hepatopatias/etiologia , Fígado/virologia , Antirreumáticos/uso terapêutico , Carcinoma Hepatocelular/epidemiologia , Carcinoma Hepatocelular/etiologia , Fígado Gorduroso/complicações , Fígado Gorduroso/epidemiologia , Fígado Gorduroso Alcoólico/complicações , Fígado Gorduroso Alcoólico/epidemiologia , Infecções por HIV/epidemiologia , Hepatite A/complicações , Hepatite A/epidemiologia , Hepatite B/complicações , Hepatite B/epidemiologia , Hepatite C/complicações , Hepatite C/epidemiologia , Hepatite D/complicações , Hepatite D/epidemiologia , Hepatite E/complicações , Hepatite E/epidemiologia , Vírus de Hepatite , Hepatite Viral Humana/epidemiologia , Humanos , Fígado/lesões , Hepatopatia Gordurosa não Alcoólica
2.
Top Antivir Med ; 27(2): 75-82, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31136997

RESUMO

The leading cause of non-HIV-related mortality is liver disease. Fatty liver disease can be characterized as alcoholic or nonalcoholic in nature. Alcohol use is prevalent among individuals with HIV infection and can lead to medication nonadherence, lower CD4+ cell count, inadequate viral suppression, and disease progression. The pathogenesis of nonalcoholic fatty liver disease (NAFLD) in individuals with HIV infection includes metabolic syndrome, hyperuricemia, HIV-related lipodystrophy, genetic polymorphisms, medications, HIV itself, and the gut microbiome. The prevalence of NAFLD in persons with HIV infection ranges from 30% to 65% depending on the modality of diagnosis. Individuals with HIV infection and NAFLD are at higher risk of cardiovascular disease; however, there is a dearth of longitudinal outcomes studies on this topic. Current therapies for NAFLD, such as vitamin E and pioglitazone, have not been studied in persons with HIV infection. There are several drugs in phase II and III clinical trials that specifically target NAFLD in HIV, including CC chemokine receptor 5 inhibitors, growth hormone-releasing factor agonists, and stearoyl-CoA desaturase inhibitors. Persons with HIV should be screened for NAFLD while pursuing aggressive risk factor modification and lifestyle changes, given the increased risk of cardiovascular mortality.


Assuntos
Fígado Gorduroso Alcoólico/epidemiologia , Infecções por HIV/complicações , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Contagem de Linfócito CD4 , Doenças Cardiovasculares/diagnóstico , Fígado Gorduroso Alcoólico/complicações , Fígado Gorduroso Alcoólico/diagnóstico , Infecções por HIV/epidemiologia , Humanos , Hepatopatia Gordurosa não Alcoólica/complicações , Hepatopatia Gordurosa não Alcoólica/diagnóstico , Prevalência , Fatores de Risco
4.
Drug Alcohol Depend ; 194: 225-229, 2019 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-30463051

RESUMO

OBJECTIVE: To evaluate the longitudinal relationship between repeated measures of alcohol consumption and risk of developing fatty liver. PATIENTS AND METHODS: This study includes 5407 men and women from a British population-based cohort, the Whitehall II study of civil servants, who self-reported alcohol consumption by questionnaire over approximately 30 years (1985-1989 through to 2012-2013). Drinking typologies during midlife were linked to measures of fatty liver (the fatty liver index, FLI) when participants were in older age (age range 60-84 years) and adjusted for age, socio-economic position, ethnicity, and smoking. RESULTS: Those who consistently drank heavily had two-fold higher odds of increased FLI compared to stable low-risk moderate drinkers after adjustment for covariates (men: OR = 2.04, 95%CI = 1.53-2.74; women: OR = 2.24, 95%CI = 1.08-4.55). Former drinkers also had an increased FLI compared to low-risk drinkers (men: OR = 2.09, 95%CI = 1.55-2.85; women: OR = 1.68, 95%CI = 1.08-2.67). There were non-significant differences in FLI between non-drinkers and stable low-risk drinkers. Among women, there was no increased risk for current heavy drinkers in cross sectional analyses. CONCLUSION: Drinking habits among adults during midlife affect the development of fatty liver, and sustained heavy drinking is associated with an increased FLI compared to stable low-risk drinkers. After the exclusion of former drinkers, there was no difference between non-drinkers and low-risk drinkers, which does not support a protective effect on fatty liver from low-risk drinking. Cross-sectional analyses among women did not find an increased risk of heavy drinking compared to low-risk drinkers, thus highlighting the need to take a longitudinal approach.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Consumo de Bebidas Alcoólicas/tendências , Fígado Gorduroso Alcoólico/epidemiologia , Vigilância da População , Autorrelato , Adulto , Idoso , Estudos de Coortes , Estudos Transversais , Fígado Gorduroso Alcoólico/diagnóstico , Feminino , Humanos , Londres/epidemiologia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Vigilância da População/métodos , Fatores de Risco , Autorrelato/normas , Fumar/epidemiologia , Fumar/tendências , Fatores de Tempo
5.
Gut ; 68(9): 1667-1675, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-30472683

RESUMO

OBJECTIVE: Recent evidence suggests that alcoholic fatty liver disease (AFLD) and non-alcoholic fatty liver disease (NAFLD) may differentially affect risk of cardiovascular mortality. To investigate whether early liver disease due to AFLD or NAFLD have similar or dissimilar effects on risk of early coronary artery atherosclerosis, we have investigated the associations between AFLD and NAFLD and coronary artery calcium (CAC). DESIGN: A cross-sectional study was performed in 105 328 Korean adults who attended a health check-up programme. CAC score was assessed using CT, daily alcohol intake was recorded as grams/day and liver fat by ultrasound. Logistic regression model was used to calculate ORs with 95% CIs for prevalent CAC. RESULTS: Both NAFLD and AFLD were positively associated with CAC score. After adjusting for potential confounders, multivariable-adjusted OR (95% CIs) for CAC >0 comparing NAFLD and AFLD to the reference (absence of both excessive alcohol use and fatty liver disease) were 1.10 (95% CI 1.05 to 1.16) and 1.20 (95% CI 1.11 to 1.30), respectively. In post hoc analysis, OR (95% CI) for detectable CAC comparing AFLD to NAFLD was 1.09 (95% CI 1.01 to 1.17). Associations of NAFLD and AFLD with CAC scores were similar in both non-obese and obese individuals without significant interaction by obesity (p for interaction=0.088). After adjusting for homeostasis model assessment of insulin resistance and high-sensitivity C reactive protein, the associations between fatty liver disease and CAC scores remained statistically significant. CONCLUSION: In this large sample of young and middle-aged individuals, early liver disease due to NAFLD and AFLD were both significantly associated with the presence of coronary artery calcification.


Assuntos
Calcinose/etiologia , Doença da Artéria Coronariana/etiologia , Fígado Gorduroso Alcoólico/complicações , Hepatopatia Gordurosa não Alcoólica/complicações , Adolescente , Adulto , Idoso , Calcinose/diagnóstico por imagem , Calcinose/epidemiologia , Angiografia por Tomografia Computadorizada , Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/epidemiologia , Estudos Transversais , Medicina Baseada em Evidências/métodos , Fígado Gorduroso Alcoólico/diagnóstico por imagem , Fígado Gorduroso Alcoólico/epidemiologia , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/diagnóstico por imagem , Hepatopatia Gordurosa não Alcoólica/epidemiologia , República da Coreia/epidemiologia , Índice de Gravidade de Doença , Ultrassonografia , Adulto Jovem
6.
Liver Int ; 39(3): 531-539, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30427105

RESUMO

BACKGROUND & AIMS: With the rising prevalence of alcoholism, obesity and metabolic syndrome, steatohepatitis will become the leading cause of end-stage liver disease and hepatocellular carcinoma in the United States by 2025. Patients with non-alcoholic steatohepatitis and alcoholic liver disease have similar clinical and histopathological presentations, whether these similarities persist in non-alcoholic steatohepatitis and alcoholic liver disease patients with hepatocellular carcinoma remains unknown. METHODS: A retrospective analysis of the clinical features of adult patients from a large transplant center who underwent liver transplantation for steatohepatitis due to non-alcoholic steatohepatitis and alcoholic causes (alcoholic liver disease) between 1/1/02 and 1/1/12 was performed. Clinical features, explant histopathology, and clinical outcomes were compared. RESULTS: Hepatocellular carcinoma was present in 80 of 317 patients, who underwent liver transplantation for steatohepatitis with equivalent distribution in non-alcoholic steatohepatitis and alcoholic liver disease patients (24% vs 26%; P = 0.8). On multivariate analysis, significant predictors of hepatocellular carcinoma included age, ethnicity (Hispanic), and diabetes, but not BMI, hypertension or smoking. A lower risk of hepatocellular carcinoma was associated with a clinical history of hyperlipidemia. Clinical parameters were similar between patients with alcoholic liver disease - hepatocellular carcinoma and non-alcoholic steatohepatitis-hepatocellular carcinoma, except sex and presence of metabolic syndrome. non-alcoholic steatohepatitis-hepatocellular carcinoma livers retained histopathological features of non-alcoholic steatohepatitis such as ballooning and Mallory bodies, while alcoholic liver disease-hepatocellular carcinoma livers did not. There were no significant differences in hepatocellular carcinoma recurrence rates or post-transplant overall survival. CONCLUSIONS: We report the largest single-center study evaluating clinical, histopathological and outcome measures of patients undergoing liver transplantation for steatohepatitis. Older patients, diabetics, and Hispanics may warrant more frequent cancer screening due to increased risk of hepatocellular carcinoma.


Assuntos
Carcinoma Hepatocelular/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Fígado Gorduroso Alcoólico/epidemiologia , Hiperlipidemias/epidemiologia , Neoplasias Hepáticas/epidemiologia , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Fatores Etários , Idoso , Carcinoma Hepatocelular/mortalidade , Carcinoma Hepatocelular/patologia , Diabetes Mellitus Tipo 2/diagnóstico , Fígado Gorduroso Alcoólico/diagnóstico , Fígado Gorduroso Alcoólico/mortalidade , Fígado Gorduroso Alcoólico/cirurgia , Feminino , Hispano-Americanos , Humanos , Hiperlipidemias/diagnóstico , Hiperlipidemias/mortalidade , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/patologia , Transplante de Fígado , Masculino , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/diagnóstico , Hepatopatia Gordurosa não Alcoólica/mortalidade , Hepatopatia Gordurosa não Alcoólica/cirurgia , Prevalência , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Resultado do Tratamento
7.
BMC Gastroenterol ; 18(1): 177, 2018 Nov 28.
Artigo em Inglês | MEDLINE | ID: mdl-30486798

RESUMO

BACKGROUND: The estimation of the burden of disease attributable to fatty liver requires studies performed in the general population. METHODS: The Bagnacavallo Study was performed between October 2005 and March 2009. All the citizens of Bagnacavallo (Ravenna, Italy) aged 30 to 60 years as of January 2005 were eligible. Altered liver enzymes were defined as alanine transaminase > 40 U/l and/or aspartate transaminase > 37 U/l. RESULTS: Four thousand and thirty-three (58%) out of 6920 eligible citizens agreed to participate and 3933 (98%) had complete data. 393 (10%) of the latter had altered liver enzymes and 3540 had not. After exclusion of subjects with HBV or HCV infection, liver ultrasonography was available for 93% of subjects with altered liber enzymes and 52% of those with normal liver enzymes. The prevalence of fatty liver, non-alcoholic fatty liver disease (NAFLD) and alcoholic fatty liver disease (AFLD) was 0.74 (95%CI 0.70 to 0.79) vs. 0.35 (0.33 to 0.37), 0.46 (0.41 to 0.51) vs. 0.22 (0.21 to 0.24) and 0.28 (0.24 to 0.33) vs. 0.13 (0.11 to 0.14) in citizens with than in those without altered liver enzymes. Ethanol intake was not associated and all the components of the metabolic syndrome (MS) were associated with fatty liver. All potential risk factors were associated with a lower odds of normal liver vs. NAFLD while they were unable to discriminate AFLD from NAFLD. CONCLUSIONS: Fatty liver as a whole was highly prevalent in Bagnacavallo in 2005/9 and was more common among citizens with altered liver enzymes.


Assuntos
Fígado Gorduroso/epidemiologia , Adulto , Alanina Transaminase/sangue , Antropometria , Aspartato Aminotransferases/sangue , Estudos Transversais , Fígado Gorduroso/diagnóstico por imagem , Fígado Gorduroso/enzimologia , Fígado Gorduroso Alcoólico/epidemiologia , Feminino , Humanos , Itália/epidemiologia , Fígado/diagnóstico por imagem , Fígado/enzimologia , Masculino , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Prevalência , Fatores de Risco , Ultrassonografia
8.
Artigo em Inglês | MEDLINE | ID: mdl-29692271

RESUMO

BACKGROUND AND OBJECTIVE: Estrogens could protect the liver from fatty degeneration, but there is little information about whether menopause is associated with the severity of alcoholic (AFL) and non-alcoholic fatty liver (NAFL). Our aim was to evaluate the distribution of fatty liver detected by ultrasound in pre- and post-menopausal women and the factors associated with these conditions. METHODS: In this cross-sectional study, the years from menopause were investigated through selfreported information. The degree of fatty liver was assessed through a standardized ultrasound examination (scores 0 to 6, higher values reflecting a greater severity). Liver steatosis was classified as NAFL or AFL based on a daily alcohol intake > 20g/d. RESULTS: The study included 752 women in menopause and 535 in pre-menopause. The years from menopause were not associated with the severity of liver steatosis in NAFL (p for trend=0.74; Spearman correlation=0.04; 95%CI: -0.09 to 0.17), whereas all the indexes of adiposity and the number of metabolic syndrome factors were associated with a higher liver steatosis score. Taking AFL liver steatosis as the outcome, the years since menopause were not significantly associated with liver steatosis in AFL (p for trend=0.50; Spearman correlation=0.09; 95%CI: -0.17 to 0.34), whilst the association between anthropometric parameters and liver steatosis severity resulted stronger in postmenopausal compared to pre- menopausal women. CONCLUSION: the higher prevalence of fatty liver observed in post-menopausal women is probably not due to menopause per se, but to the adiposity (particularly abdominal) typical of this age and its consequences (such as metabolic syndrome).


Assuntos
Fígado Gorduroso Alcoólico/diagnóstico por imagem , Fígado/diagnóstico por imagem , Menopausa , Hepatopatia Gordurosa não Alcoólica/diagnóstico por imagem , Adiposidade , Adulto , Idoso , Estudos Transversais , Fígado Gorduroso Alcoólico/epidemiologia , Feminino , Humanos , Itália/epidemiologia , Fígado/fisiopatologia , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Hepatopatia Gordurosa não Alcoólica/fisiopatologia , Pós-Menopausa , Pré-Menopausa , Prevalência , Prognóstico , Fatores de Risco , Índice de Gravidade de Doença
9.
Nutrients ; 10(1)2018 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-29342916

RESUMO

Coffee drinking seems to have several beneficial effects on health outcomes. However, the effect on hepatic steatosis, depending on a high alcohol consumption (AFLD, alcoholic fatty liver disease) or on metabolic factors (non-alcoholic fatty liver disease, NAFLD), is still equivocal. Thus, we aimed to explore the potential association between coffee consumption and the presence and severity of hepatic steatosis in people with NAFLD or AFLD. In this cross-sectional study, coffee drinking was recorded using a semi-quantitative food frequency questionnaire, and categorized as yes vs. no and as 0, 1, 2, ≥3. The degree of fatty liver was assessed through a standardized ultrasound examination (score 0 to 6, with higher values reflecting higher severity). Liver steatosis was classified as NAFLD or AFLD on daily alcohol intake >30 g/day for men and >20 g/day for women. This study included 2819 middle-aged participants; the great majority were coffee drinkers (86.1%). After adjusting for 12 potential confounders, drinking coffee was not associated with decreased odds for NAFLD (n = 916) (odds ratio, OR = 0.93; 95% confidence intervals, CI: 0.72-1.20) or AFLD (n = 276) (OR = 1.20; 95% CI: 0.66-2.0). The consumption of coffee (categorized as yes vs. no), or an increased consumption of coffee were not associated with the presence of mild, moderate or severe liver steatosis in either NAFLD or AFLD. In conclusion, coffee intake was not associated with any lower odds of hepatic steatosis in either non-alcoholic or alcoholic forms in this large cohort of South Italian individuals.


Assuntos
Café/efeitos adversos , Fígado Gorduroso Alcoólico/epidemiologia , Fígado Gorduroso/diagnóstico , Fígado Gorduroso/epidemiologia , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Consumo de Bebidas Alcoólicas/efeitos adversos , Pressão Sanguínea , Índice de Massa Corporal , Estudos Transversais , Fígado Gorduroso/etiologia , Fígado Gorduroso Alcoólico/complicações , Feminino , Humanos , Itália/epidemiologia , Modelos Logísticos , Masculino , Região do Mediterrâneo/epidemiologia , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/complicações , Prevalência , Inquéritos e Questionários , Circunferência da Cintura
10.
Hepatol Int ; 12(1): 56-66, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29189974

RESUMO

OBJECTIVE: To investigate the associations between SIRT1 polymorphisms and their expression in patients with alcoholic fatty liver disease (AFLD). METHODS: A total of 268 heavy drinkers were divided into the AFLD group (n = 176) and alcoholic control (n = 92) and 237 light-/non-drinkers into the NAFLD (non-AFLD) group (n = 117) and healthy control (n = 120). The genotyping of SIRT1 (rs33957861, rs11599176, rs12413112 and rs35689145) was detected by the Sequenom MassARRAY iPLEX test. The mRNA and protein expressions of SIRT1 were determined by quantitative real-time polymerase chain reaction (qRT-PCR) and enzyme-linked immunosorbent assays (ELISA), respectively. RESULTS: SIRT1 gene rs33957861 and rs11599176 polymorphisms significantly reduce the risk of NAFLD and AFLD, while rs35689145 remarkably increases the risk. Haplotypes of AAAA (rs33957861-rs11599176-rs12413112-rs35689145), AAAA, CAGA and CGAA can appreciably lower the presence of AFLD, but CAAG had an elevated AFLD risk. Besides, in the NAFLD and AFLD groups, a decreased BMI was found in the mutant genotype carriers of rs33957861, rs11599176 and rs12413112, but an increased BMI was observed in the rs35689145 mutant genotype carriers when compared to those with the wild-type homozygous genotype ones. Furthermore, rs33957861 C>T, rs11599176 A>G and BMI were independent risk factors of AFLD. There was no difference among four SNPs of SIRT1 and its mRNA and protein expressions in all groups. CONCLUSION: SIRT1 polymorphisms and their expression were associated with the presence of AFLD, and there was a close relationship among four SNPs and BMI in AFLD patients, but no SNP was related to its expression.


Assuntos
Fígado Gorduroso Alcoólico/epidemiologia , Predisposição Genética para Doença , Sirtuína 1/genética , Grupo com Ancestrais do Continente Asiático , China/epidemiologia , Ensaio de Imunoadsorção Enzimática , Fígado Gorduroso Alcoólico/genética , Feminino , Regulação Enzimológica da Expressão Gênica , Humanos , Masculino , Pessoa de Meia-Idade , Polimorfismo de Nucleotídeo Único , Reação em Cadeia da Polimerase em Tempo Real
12.
Ann Hepatol ; 15(4): 463-73, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27236145

RESUMO

 The burden of alcoholic liver disease continues to be a major public health problem worldwide. The spectrum of disease ranges from fatty liver to cirrhosis and hepatocellular carcinoma. Alcoholic hepatitis (AH) is a type of acute-on-chronic liver failure and the most severe form of alcoholic liver disease. Severe AH carries a poor short-term prognosis and its management is still challenging, with scarce advances in the last decades. Corticosteroids are still the first line of therapy in severe cases. Unfortunately, many patients do not respond and novel targeted therapies are urgently needed. Liver transplantation has shown extraordinary results in non-responders to corticosteroids however; its applicability is very low. This review summarizes the epidemiology, natural history, risk factors and pathogenesis of alcoholic liver disease with special focus on the latest advances in prognostic stratification and therapy of patients with alcoholic hepatitis.


Assuntos
Insuficiência Hepática Crônica Agudizada/fisiopatologia , Fígado Gorduroso Alcoólico/fisiopatologia , Hepatite Alcoólica/fisiopatologia , Insuficiência Hepática Crônica Agudizada/epidemiologia , Insuficiência Hepática Crônica Agudizada/terapia , Corticosteroides/uso terapêutico , Fígado Gorduroso Alcoólico/epidemiologia , Fígado Gorduroso Alcoólico/terapia , Hepatite Alcoólica/epidemiologia , Hepatite Alcoólica/terapia , Humanos , Cirrose Hepática Alcoólica/epidemiologia , Cirrose Hepática Alcoólica/fisiopatologia , Cirrose Hepática Alcoólica/terapia , Transplante de Fígado , Prognóstico , Fatores de Risco
13.
Ann Hepatol ; 15(2): 183-9, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26845595

RESUMO

BACKGROUND AND OBJECTIVE: Steatohepatitis is a common cause of liver disease due to alcohol (ALD) or non-alcoholic fatty liver disease (NAFLD). We performed this study to compare natural history of ALD and NAFLD. MATERIAL AND METHODS: Retrospective analysis of ALD or NAFLD patients managed at our center (2007-2011). ALD diagnosed by excluding other liver diseases (except HCV) and alcohol abuse of > 40 g/d in women and > 60 g/d in men for > 5 years. NAFLD diagnosed by excluding other liver diseases and a history of alcohol use of < 10 g/d. Cirrhosis was diagnosed using biopsy for uncertain clinical diagnosis. RESULTS: Compared to patients with NAFLD (n = 365; mean age 50 yrs; 43% males; 53% diabetic), ALD patients (n = 206; mean age 51 yrs; 68% males; 24% diabetic) presented more often with cirrhosis or complications(46vs. 12%; P< 0.0001) with a higher MELD score (13 ± 7 vs. 8 ± 8; P<0.0001). On logistic regression, ALD diagnosis was associated with presence of cirrhosis by over 4-fold (4.1 [1.8-9.1]) even after excluding 23 patients with concomitant HCV. Over median follow up of about 3 and 4 yrs among ALD and NAFLD patients respectively, ALD patients more frequently developed cirrhosis or its complications including HCC with worse transplant free survival (90 vs. 95%; P = 0.038). CONCLUSIONS: Compared to NAFLD, ALD patients present at an advanced stage of liver disease with a faster progression on follow-up. Prospective multicenter studies are needed to identify potential barriers to early referral of ALD patients as basis for development of strategies to improve outcome of patients with ALD.


Assuntos
Fígado Gorduroso Alcoólico/fisiopatologia , Cirrose Hepática Alcoólica/fisiopatologia , Hepatopatia Gordurosa não Alcoólica/fisiopatologia , Adulto , Comorbidade , Progressão da Doença , Fígado Gorduroso Alcoólico/diagnóstico , Fígado Gorduroso Alcoólico/epidemiologia , Feminino , Humanos , Cirrose Hepática/diagnóstico , Cirrose Hepática/epidemiologia , Cirrose Hepática/fisiopatologia , Cirrose Hepática Alcoólica/diagnóstico , Cirrose Hepática Alcoólica/epidemiologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/diagnóstico , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença
15.
Zhonghua Gan Zang Bing Za Zhi ; 23(9): 680-3, 2015 Sep.
Artigo em Chinês | MEDLINE | ID: mdl-26524362

RESUMO

OBJECTIVE: To study the clinical characteristics of patients with alcoholic liver disease (ALD). METHODS: The records of the 302 Hospital of People's Liberation Army (Beijing, China) were searched to identify patients diagnosed with liver disease for retrospective analysis of ALD. Measurement data was summarized as mean +/- standard deviation and intergroup comparisons were made using ANOVA; count data was assessed using the chi-square test. RESULTS: Among the total 4132 ALD cases, 97.68% were male and 2.32% were female; ages ranged from 18 to 95 years-old,with the average age being 48.11+/-10.58 years and the range of 40 to 60 years-old being the most frequently represented.Considering all patients with liver disease from 2003 to 2012,ALD cases increased over time (from 2.00% in 2003 to 5.05% in 2012). The overall ALD cases were represented by alcoholic cirrhosis (70.35%), alcoholic hepatitis (19.26%), alcoholic fatty liver (6.29%), and alcoholic liver failure (4.09%). Among the ALD patients between 40 and 60 years of age, 73.81% had cirrhosis,compared to 50.42% of ALD patients less than 40 years-old (P less than 0.001). Comparison of ALD cases in 5-year increments showed increasing trends in rates of alcoholic cirrhosis and alcoholic hepatic failure;moreover, there was an increasing annual trend in the percentage of alcoholic liver failure cases among the total cases of liver failure in our hospital. CONCLUSION: From 2003 to 2012,our hospital admissions increased for patients with alcoholic liver disease, and the patients were primarily in the age range of 40-60 years-old. In general, incidences of alcoholic liver failure and cirrhosis increased in recent years, and cirrhosis has been common among the elderly patients with ALD.


Assuntos
Hepatopatias Alcoólicas/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Pequim , Fígado Gorduroso Alcoólico/epidemiologia , Feminino , Hepatite Alcoólica/epidemiologia , Humanos , Incidência , Cirrose Hepática/epidemiologia , Falência Hepática/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
16.
Alcohol Clin Exp Res ; 39(6): 1027-33, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25941109

RESUMO

BACKGROUND: Among its pleiotropic effects, vitamin D may protect the liver from fibrosis and/or inflammation. However, the impact of vitamin D on liver pathology in hepatitis C remains unclear, and very few studies including alcoholic patients with liver pathologies have been performed. Here we compared the levels of 25-OH vitamin D in the blood of alcoholic patients with the occurrence of alcoholic steatohepatitis (ASH) or bridging fibrosis. METHODS: One hundred and one alcoholic patients were included. All the patients received a liver biopsy, and the levels of 25-OH vitamin D were evaluated with the Liaison 25-OH vitamin D assay. Logistic regression analyses were performed to obtain predictive factors of liver histology. RESULTS: Among alcoholic patients, 40.6% presented ASH and 39.6% presented bridging fibrosis. A severe deficiency in 25-OH vitamin D (<10 ng/ml) was seen in 60.4% of patients. This deficiency was frequent in patients with ASH (85.4%) and in those with bridging fibrosis (80%) but was independently associated only with ASH (odds ratio = 8.46 [95% confidence interval 2.05 to 34.89], p = 0.003). CONCLUSIONS: In alcoholic patients, a severe deficiency in 25-OH vitamin D was independently associated with the occurrence of ASH.


Assuntos
Fígado Gorduroso Alcoólico/complicações , Fígado Gorduroso Alcoólico/epidemiologia , Deficiência de Vitamina D/complicações , Deficiência de Vitamina D/epidemiologia , Adulto , Alcoolismo/sangue , Alcoolismo/complicações , Calcifediol/sangue , Fígado Gorduroso Alcoólico/sangue , Feminino , Fibrose/complicações , Fibrose/epidemiologia , França/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Deficiência de Vitamina D/sangue
17.
BMC Gastroenterol ; 15: 32, 2015 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-25887997

RESUMO

BACKGROUND: The presence of diabetes mellitus (DM) is associated with increased liver morbidity and mortality risk in patients with chronic hepatitis B (CHB). Aim of this study was to identify factors associated with type 2 diabetes mellitus (T2DM) in CHB patients. METHODS: A cross-sectional study with pair-matched controls was conducted in Nantong Third People's Hospital, Nantong University, China. From January 2008 to December 2012, a total of 1783 CHB patients were screened for study subjects, among whom 207 patients with T2DM were enrolled as cases and 207 sex- and age-matched non-DM patients as controls. Demographic, anthropometric, lifestyle, clinical, and laboratory data were obtained from each subject. RESULTS: In the univariate model, thirteen variables showed marked differences between the DM group and non-DM group. Patients with longer duration of CHB (≥15 years) and alcoholic steatosis showed the highest likelihood of T2DM (odds ratio = 5.39 and 4.95; 95% confidence intervals 2.76-10.53 and 1.65-14.91). In the multivariate adjusted analysis, three CHB-related factors, namely high viral load, long duration of illness, and presence of cirrhosis, contributed to substantially increase the likelihood of T2DM, in addition to the other five risk factors including family history of DM, low education level, elevated triglycerides (TG), gamma-glutamyl transferase (GGT) levels, and presence of alcoholic steatosis. CONCLUSIONS: Our findings suggest that high viral load, long duration of CHB, presence of cirrhosis, alcoholic steatosis and several other factors may be potential risk factors for development of T2DM in CHB patients. It is of vital importance to monitor glucose in high-risk CHB patients and aggressively intervene on modifiable risk factors.


Assuntos
Diabetes Mellitus Tipo 2/etiologia , Hepatite B Crônica/complicações , Adulto , Estudos de Casos e Controles , China/epidemiologia , Estudos Transversais , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/genética , Escolaridade , Fígado Gorduroso Alcoólico/epidemiologia , Feminino , Hepatite B Crônica/sangue , Hepatite B Crônica/epidemiologia , Humanos , Hipertrigliceridemia/epidemiologia , Cirrose Hepática/epidemiologia , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fatores de Tempo , Carga Viral , gama-Glutamiltransferase/sangue
18.
BMC Fam Pract ; 16: 34, 2015 Mar 11.
Artigo em Inglês | MEDLINE | ID: mdl-25879823

RESUMO

BACKGROUND: The purpose of this study was to determine whether general practitioner visits for alcohol-attributed diseases increased in a decade when several regulatory changes were made to the distribution and price of alcohol in British Columbia Canada. METHODS: General practitioner consultations for alcohol-attributed diseases were examined using data from British Columbia's Medical Services Plan database. Negative binomial regression was used to measure the significance of yearly variations using incidence rate ratios by disease type per year. RESULTS: From 2001 to 2011, 690,401 visits were made to general practitioners by 198,623 persons with alcohol-attributed diseases. Most visits (86.2%) were for alcohol dependency syndrome (N = 595,371). General practitioner visits for alcohol-attributed diseases increased significantly (p < .001) by 53.3% from 14,882 cases in 2001 to 22,823 cases in 2011. While the number of cases increased from 2001-2011, the frequency of visits to general practitioners significantly decreased from 3.9 in 2001 to 2.7 visits per case in 2011 (F = 428.1, p < .001). CONCLUSION: From 2001 to 2011 there were significant increases in the number of persons presenting to general practitioners with alcohol-attributed diseases in British Columbia. The results of this study demonstrate the need to provide enhanced support to general practitioners in the treatment of patients with substance use disorders given the increasing number of primary health care patients with alcohol-attributed diseases.


Assuntos
Transtornos Relacionados ao Uso de Álcool/terapia , Medicina Geral/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Adulto , Transtornos Relacionados ao Uso de Álcool/epidemiologia , Alcoolismo/epidemiologia , Colúmbia Britânica/epidemiologia , Fígado Gorduroso Alcoólico/epidemiologia , Feminino , Hepatite Alcoólica/epidemiologia , Humanos , Classificação Internacional de Doenças , Cirrose Hepática Alcoólica/epidemiologia , Masculino , Pessoa de Meia-Idade
19.
J Gastroenterol ; 50(11): 1114-23, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25733100

RESUMO

BACKGROUND: Fatty liver is an important clinical feature not only in alcoholic and non-alcoholic fatty liver diseases, but in other chronic liver diseases as well. Our aim was to elucidate the effect and relationship between habitual alcohol intake and obesity in the development of fatty liver disease. METHODS: We enrolled 8,029 subjects undergoing abdominal ultrasonography with general medical examinations, and analyzed the factors associated with fatty liver based on daily alcohol intake, body mass index (BMI), and waist circumference. RESULTS: For fatty liver, BMI, waist circumference, total cholesterol, triglycerides, and fasting plasma glucose were significant and independent risk factors. Heavy alcohol intake (50 g/day) was a significant risk factor for fatty liver in women (odds ratio [OR], 3.35). Analysis based on the presence or absence of obesity revealed that moderate alcohol intake was a significant negative risk factor for fatty liver in both male and female obese (BMI ≥25 kg/m(2)) subjects (OR, 0.74 for non-obese and 0.39 for obese patients, respectively). Heavy alcohol intake was also a significant negative risk factor in obese males (0.62). In contrast, heavy alcohol intake was a risk factor in non-obese males (OR, 1.29) and in all females (OR, 2.22 for non-obese and 6.6 for obese patients, respectively). CONCLUSIONS: The influence of alcohol intake on fatty liver differed depending on the level of alcohol consumption, gender, and the presence of obesity, and showed biphasic effects.


Assuntos
Consumo de Bebidas Alcoólicas/efeitos adversos , Fígado Gorduroso/etiologia , Adulto , Fatores Etários , Consumo de Bebidas Alcoólicas/epidemiologia , Alcoolismo/complicações , Alcoolismo/epidemiologia , Antropometria/métodos , Índice de Massa Corporal , Estudos Transversais , Etanol/administração & dosagem , Fígado Gorduroso/epidemiologia , Fígado Gorduroso Alcoólico/epidemiologia , Fígado Gorduroso Alcoólico/etiologia , Feminino , Humanos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Obesidade/epidemiologia , Prevalência , Fatores de Risco , Fatores Sexuais , Circunferência da Cintura
20.
Alcohol Alcohol ; 50(3): 352-7, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25681463

RESUMO

AIMS: To describe incidence, prevalence, hospitalization rates and survival for alcoholic liver disease (ALD) in Denmark 2006-2011. METHODS: Using nationwide healthcare registries we identified all Danish residents with a hospital diagnosis of ALD and computed standardized incidence, prevalence, and hospitalization rates in 2006-2011, age- and birth cohort-specific incidence for the 1930-1974 birth cohorts, and 1- and 5-year survival. RESULTS: In 2006-2011, the overall standardized ALD incidence decreased from 343 to 311 per 1,000,000 population per year. ALD incidence increased among women aged 65 years or older, but decreased in younger persons and men. Persons born in 1950-1959 had higher age-specific incidence than earlier and later birth cohorts. The prevalence (0.2% of the Danish adult population) and hospitalization rate were constant. The 1- and 5-year survival were 43 and 70%, respectively. CONCLUSION: In Denmark, persons born in 1950-1959 have had the highest age-specific incidence. The overall ALD incidence has been decreasing (along with per capita consumption). Despite increases in affordability during the study period, Denmark did not experience the increase in ALD seen, for example, in the UK. It is possible that this is due to the greater impact of government recommendations on safer drinking in Denmark than the UK.


Assuntos
Fígado Gorduroso Alcoólico/epidemiologia , Hepatite Alcoólica/epidemiologia , Hospitalização/estatística & dados numéricos , Cirrose Hepática Alcoólica/epidemiologia , Sistema de Registros , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Dinamarca/epidemiologia , Fígado Gorduroso Alcoólico/mortalidade , Feminino , Hepatite Alcoólica/mortalidade , Humanos , Incidência , Cirrose Hepática Alcoólica/mortalidade , Hepatopatias Alcoólicas/epidemiologia , Hepatopatias Alcoólicas/mortalidade , Masculino , Pessoa de Meia-Idade , Prevalência , Distribuição por Sexo
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