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1.
Rev Med Suisse ; 16(704): 1544-1547, 2020 Sep 02.
Artigo em Francês | MEDLINE | ID: mdl-32880109

RESUMO

Non-alcoholic fatty liver disease (NAFLD) includes a spectrum of hepatic pathology ranging from non-alcoholic fatty liver, non-alcoholic steatohepatitis (NASH) occasionally complicated with hepatic fibrosis or even cirrhosis. In order to propose a diagnosis with positive criteria, a panel of experts recently proposed the use of an alternative nomenclature, metabolic-dysfunction-associated fatty liver disease (MAFLD) whose use remains debated. In addition, in Switzerland and elsewhere, there is strong epidemiological growth of NAFLD. The next years will probably see the approval of new therapies for NAFLD/NASH but, at present, management remains focused on lifestyle interventions and joint monitoring by the primary care physician and, when necessary, the specialist.


Assuntos
Hepatopatia Gordurosa não Alcoólica , Terminologia como Assunto , Humanos , Cirrose Hepática , Hepatopatia Gordurosa não Alcoólica/classificação , Hepatopatia Gordurosa não Alcoólica/diagnóstico , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Hepatopatia Gordurosa não Alcoólica/terapia , Suíça
2.
Medicine (Baltimore) ; 99(33): e21038, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32871978

RESUMO

The association between non-alcoholic fatty liver disease (NAFLD) and diabetic kidney disease assessed using either albuminuria or proteinuria remains controversial. This study aimed to investigate the association between hepatic steatosis or fibrosis and albuminuria or proteinuria in Korean patients with type 2 diabetes mellitus (T2D).We enrolled 1108 patients with T2D and categorized as 3 groups; non-proteinuria (NP), isolated non-albumin proteinuria (iNAP), and albuminuria. Urinary albumin and protein levels were assessed as urinary albumin-to-creatinine ratio (uACR) and urinary protein-to-creatinine ratio (uPCR), respectively. Hepatic steatosis and fibrotic burden were assessed using the NAFLD liver fat score, Fibrosis-4 calculator (FIB-4) index, and NAFLD fibrosis score (NFS).The prevalence of significant steatosis was similar among groups (NP: 74.6% vs iNAP: 70.3% vs albuminuria: 79.9%, P = .085). The prevalence of significant fibrosis was significantly higher in the iNAP (18.7%) and albuminuria (16.5%) groups than in the NP group (9.5%, P = .001). Both uPCR and uACR showed a correlation with NFS (uPCR: r = 0.123, P < .001; uACR: r = 0.064, P = .033). In multivariate logistic regression analysis, uPCR ≥150 mg/g was found to have a stronger association with hepatic fibrosis than uACR ≥30 mg/g (adjusted odds ratio 1.55 [95% CI 1.03-2.33] vs adjusted odds ratio 1.16 [95% CI, 0.72-1.87]).In conclusion, patients with iNAP and albuminuria had a higher prevalence of hepatic fibrosis than those without proteinuria. Total proteinuria was associated with advanced liver fibrosis, whereas albuminuria was related to hepatic steatosis.


Assuntos
Diabetes Mellitus Tipo 2/epidemiologia , Cirrose Hepática/epidemiologia , Proteinúria/epidemiologia , Nefropatias Diabéticas/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Prevalência , República da Coreia , Estudos Retrospectivos
3.
PLoS One ; 15(8): e0236977, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32822391

RESUMO

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is increasingly widespread with an overall global estimated prevalence of 25%. Type 2 diabetes Mellitus (T2DM) is a key contributor to NAFLD progression and predicts moderate-severe liver fibrosis and mortality. However, there is currently no uniform consensus on routine NAFLD screening among T2DM patients, and the risk factors of NAFLD and advanced fibrosis among T2DM patients remain to be clarified fully. AIM: We explored the prevalence, clinical spectrum, and risk factors of NAFLD and liver fibrosis among T2DM patients. METHODS: This is a cross-sectional study that enrolled subjects from a primary care clinic and a diabetes centre in Singapore. Subjects aged 21 to 70 years of all ethnic groups with an established T2DM diagnosis were included. Subjects with chronic liver diseases of other aetiologies were excluded. All subjects underwent transient elastography for hepatic steatosis and fibrosis assessment. Their demographics, anthropometric measurements and clinical parameters were collected. Statistical analysis was performed using STATA/SE16.0 software. RESULTS: Among 449 enrolled T2DM subjects, 436 with complete data and valid transient elastography results were analysed. Overall, 78.72% (344/436) of the T2DM subjects had NAFLD, of which 13.08% (45/344) had increased liver stiffness. Higher ALT level (OR = 1.08; 95% CI: 1.03-1.14; p = 0.004), obesity (BMI ≥ 27.5 kg/m2, OR = 2.64; 95% CI: 1.28-5.44; p = 0.008) and metabolic syndrome (OR = 4.36; 95% CI 1.40-13.58; p = 0.011) were independent factors associated with increased CAP (NAFLD). Higher AST level (OR = 1.06; 95% CI: 1.02-1.11; p = 0.008), CAP value (OR = 1.02; 95% CI: 1.00-1.03; p = 0.003), lower platelet count (OR = 0.99; 95% CI: 0.98-1.00; p = 0.009) and concomitant hypertension (OR = 4.56; 95% CI: 1.18-17.62; p = 0.028) were independent factors associated with increased liver stiffness. CONCLUSIONS: Our study demonstrated a considerably high prevalence of NAFLD among T2DM patients, with the proportion of advanced liver fibrosis among T2DM NAFLD patients much higher than the general population. Given that NAFLD is largely asymptomatic, increased awareness and vigilance for identifying NAFLD and increased liver stiffness among T2DM patients should be advocated.


Assuntos
Diabetes Mellitus Tipo 2/complicações , Hepatopatia Gordurosa não Alcoólica/complicações , Adulto , Idoso , Estudos Transversais , Diabetes Mellitus Tipo 2/diagnóstico por imagem , Técnicas de Imagem por Elasticidade , Feminino , Humanos , Cirrose Hepática/complicações , Cirrose Hepática/diagnóstico por imagem , Cirrose Hepática/epidemiologia , Masculino , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/diagnóstico por imagem , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Prevalência , Fatores de Risco , Singapura/epidemiologia , Adulto Jovem
4.
Zhonghua Liu Xing Bing Xue Za Zhi ; 41(6): 824-828, 2020 Jun 10.
Artigo em Chinês | MEDLINE | ID: mdl-32564543

RESUMO

Objective: To investigate the relationship between waist circumference trajectory and new-onset nonalcoholic fatty liver disease (NAFLD) in the non-obese population. Methods: The study cohort was composed of the ones who met the selection criteria in Kailuan study. Waist circumference trajectories of the participants in 2006-2007, 2008-2009 and 2010-2011 were determined by SAS Proc Traj program. Four groups with different waist circumference trajectories were generated, including low-, medium-, medium-high- and high-stability groups. All groups were followed up for their health conditions in 2012-2013, 2014-2015 and 2016-2017, respectively. Incidence rates of NAFLD during physical examination were compared among different waist circumference trajectory groups. Cox regression model was used to analyze the correlation between different waist circumference trajectory groups and new-onset NAFLD. Results: Finally, 12 477 observers were included in the statistical analysis, including 8 181 males and 4 296 females. There were 1 026 (8.2%), 5 183 (41.5%), 5 481 (44.0%) and 787 cases (6.3%) in the low, medium, medium-high and high stability-stability groups, respectively. There were 4 123 NAFLD cases occurred during the follow-up period. The cumulative incidence of NAFLD increased along with the increase of waist circumference trajectory (21%, 43%, 59%, 72%, respectively) (P<0.01). The risks of NAFLD were 2.411 (95%CI: 2.021-2.877), 4.050 (95%CI: 3.402-4.820) and 5.489 (95%CI: 4.506-6.686) times higher in medium-, medium-high- and high-stability group than that in the low-stability group (P<0.01). After adjusting for age, sex and other confounding factors, the risks of NAFLD in the medium-, medium-high- and high-stability groups were 2.150 (95%CI: 1.789-2.582), 3.176 (95%CI: 2.623-3.846) and 3.732 (95%CI: 2.987-4.662) times higher than that in the low-stability group. Conclusion: The risk of NAFLD in non-obese people increased along with the increase of waist circumference trajectory, which seemed to have played an independent risk factor for NAFLD.


Assuntos
Hepatopatia Gordurosa não Alcoólica/epidemiologia , Circunferência da Cintura , China/epidemiologia , Estudos de Coortes , Feminino , Humanos , Incidência , Masculino , Obesidade/epidemiologia , Fatores de Risco
5.
PLoS One ; 15(6): e0234985, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32569304

RESUMO

BACKGROUND: Nonalcoholic Fatty Liver Disease (NAFLD) is a common co-morbidity of obesity. Elevated TSH levels (eTSH), also associated with obesity, may contribute to the dysmetabolic state that predisposes to NAFLD. OBJECTIVE: To assess the relationship between TSH levels and NAFLD in children with biopsy-proven NAFLD compared to controls. DESIGN AND METHODS: In this retrospective study of children with biopsy-proven NAFLD and age-matched controls, the association of eTSH with NAFLD was investigated and the role of TSH as a mediator between obesity and NAFLD was assessed. RESULTS: Sixty-six cases and 4067 controls (69.7 vs 59% Hispanic/Latino ancestry, p = 0.1) of the same age range seen in the same time duration at an urban Children's Hospital were studied. Children with NAFLD were more likely to be male (74.6 vs 39.4%, p < 0.001), have higher modified BMI-z scores (median 2.4 (IQR 1.7) vs 1.9 (IQR 1.7), p < 0.001), and abnormal metabolic parameters (TSH, ALT, HDL-C, non-HDL-C, and TG). Multivariate analyses controlling for age, sex and severity of obesity showed significant association between the 4th quartile of TSH and NAFLD. Causal mediation analysis demonstrates that TSH mediates 33.8% of the effect of modified BMI-z score on NAFLD. This comprises of 16.0% (OR = 1.1, p = 0.002) caused by the indirect effect of TSH and its interaction with modified BMI-z, and 17.7% (OR = 1.1, p = 0.05) as an autonomous effect of TSH on NAFLD. Overall, 33.8% of the effect can be eliminated by removing the mediator, TSH (p = 0.001). CONCLUSIONS: The association of eTSH and biopsy-proven NAFLD is demonstrated in children of Hispanic/Latino ancestry. Further, a causal mediation analysis implicates an effect of TSH on NAFLD, independent of obesity.


Assuntos
Hepatopatia Gordurosa não Alcoólica , Obesidade Pediátrica , Tireotropina/sangue , Adolescente , Biomarcadores/sangue , Criança , Estudos de Coortes , Feminino , Hispano-Americanos , Humanos , Masculino , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Hepatopatia Gordurosa não Alcoólica/metabolismo , Obesidade Pediátrica/epidemiologia , Obesidade Pediátrica/metabolismo , Estudos Retrospectivos , Fatores de Risco , Estados Unidos/epidemiologia
6.
Medicine (Baltimore) ; 99(24): e20351, 2020 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-32541457

RESUMO

BACKGROUND: This study will systematically synthesize the evidence on the potential association between non-alcoholic fatty liver (NAFL) and acute cerebral infarction (ACI). METHODS: We will propose literature search in electronic databases (MEDLINE, EMBASE, Cochrane Library, Scopus, Web of Science, WANGFANG, and China National Knowledge Infrastructure) from the source to March 1, 2020. There are no restrictions related to the language and publication status. Two review authors will separately carry out records selection, data extraction and study quality assessment. Any divisions will be solved by discussion with consulting a third review author. We will use RevMan 5.3 software to perform data analysis. RESULTS: The present study will afford additional insight into the investigation the association between NAFL and ACI. CONCLUSION: The results of this study will provide helpful evidence to explore the association between NAFL and ACI.Study registration number: INPLASY202040102.


Assuntos
Isquemia Encefálica/patologia , Infarto Cerebral/complicações , Hepatopatia Gordurosa não Alcoólica/complicações , Doença Aguda , Infarto Cerebral/epidemiologia , China/epidemiologia , Feminino , Humanos , Masculino , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Avaliação de Resultados em Cuidados de Saúde
7.
Ann Saudi Med ; 40(4): 273-280, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32564624

RESUMO

In December 2019, a novel coronavirus was identified in patients in Wuhan, China. The virus, subsequently named severe acute respiratory syndrome coronavirus-2, spread worldwide and the disease (coronavirus disease 2019 or COVID-19) was declared a global pandemic by the World Health Organization in March 2020. Older adults and individuals with comorbidities have been reported as being more vulnerable to COVID-19. Patients with chronic liver disease (CLD) have compromised immune function due to cirrhosis and are more susceptible to infection. However, it is unclear if patients with CLD are more vulnerable to COVID-19 and its complications than other populations. The high number of severe cases of COVID-19 has placed an unusual burden on health systems, compromising their capacity to provide the regular care that patients with CLD require. Hence, it is incredibly crucial at this juncture to provide a set of interim recommendations on the management of patients with CLD during the current COVID-19 outbreak.


Assuntos
Infecções por Coronavirus/epidemiologia , Hepatopatias/epidemiologia , Pneumonia Viral/epidemiologia , Monofosfato de Adenosina/efeitos adversos , Monofosfato de Adenosina/análogos & derivados , Corticosteroides/efeitos adversos , Alanina/efeitos adversos , Alanina/análogos & derivados , Amidas/efeitos adversos , Antivirais/uso terapêutico , Azetidinas/efeitos adversos , Betacoronavirus , Biópsia/métodos , Carcinoma Hepatocelular/epidemiologia , Carcinoma Hepatocelular/terapia , Comorbidade , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/prevenção & controle , Combinação de Medicamentos , Interações Medicamentosas , Inibidores Enzimáticos/efeitos adversos , Hepatite Autoimune/epidemiologia , Hepatite Autoimune/terapia , Hepatite Viral Humana/epidemiologia , Hepatite Viral Humana/terapia , Humanos , Hidroxicloroquina/efeitos adversos , Imunossupressores/uso terapêutico , Inibidores de Janus Quinases/efeitos adversos , Cirrose Hepática/epidemiologia , Cirrose Hepática/terapia , Hepatopatias/terapia , Neoplasias Hepáticas/epidemiologia , Neoplasias Hepáticas/terapia , Transplante de Fígado , Lopinavir/efeitos adversos , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Hepatopatia Gordurosa não Alcoólica/terapia , Pandemias/prevenção & controle , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/prevenção & controle , Pirazinas/efeitos adversos , Ritonavir/efeitos adversos , Arábia Saudita/epidemiologia , Sulfonamidas/efeitos adversos , Ultrassonografia/métodos
9.
Eur J Clin Invest ; 50(10): e13338, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32589264

RESUMO

BACKGROUND: Initial evidence from China suggests that most vulnerable subjects to COVID-19 infection suffer from pre-existing illness, including metabolic abnormalities. The pandemic characteristics and high-lethality rate of COVID-19 infection have raised concerns about interactions between virus pathobiology and components of the metabolic syndrome. METHODS: We harmonized the information from the recent existing literature on COVID-19 acute pandemic and mechanisms of damage in non-alcoholic fatty liver disease (NAFLD), as an example of chronic (non-communicable) metabolic pandemic. RESULTS: COVID-19-infected patients are more fragile with underlying metabolic illness, including hypertension, cardiovascular disease, type 2 diabetes, chronic lung diseases (e.g. asthma, chronic obstructive pulmonary disease and emphysema) and metabolic syndrome. During metabolic abnormalities, expansion of metabolically active fat ('overfat condition') parallels chronic inflammatory changes, development of insulin resistance and accumulation of fat in configuring NAFLD. The deleterious interplay of inflammatory pathways chronically active in NAFLD and acutely in COVID-19-infected patients, can explain liver damage in a subgroup of patients and might condition a worse outcome in metabolically compromised NAFLD patients. In a subgroup of patients with NAFLD, the underlying liver fibrosis might represent an additional and independent risk factor for severe COVID-19 illness, irrespective of metabolic comorbidities. CONCLUSIONS: NAFLD can play a role in the outcome of COVID-19 illness due to frequent association with comorbidities. Initial evidences suggest that increased liver fibrosis in NAFLD might affect COVID-19 outcome. In addition, long-term monitoring of post-COVID-19 NAFLD patients is advisable, to document further deterioration of liver damage. Further studies are required in this field.


Assuntos
Infecções por Coronavirus/epidemiologia , Síndrome Metabólica/epidemiologia , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Pneumonia Viral/epidemiologia , Betacoronavirus , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/metabolismo , Síndrome da Liberação de Citocina/imunologia , Humanos , Inflamação/imunologia , Resistência à Insulina , Fígado/imunologia , Fígado/metabolismo , Síndrome Metabólica/imunologia , Síndrome Metabólica/metabolismo , Hepatopatia Gordurosa não Alcoólica/imunologia , Hepatopatia Gordurosa não Alcoólica/metabolismo , Pandemias , Pneumonia Viral/imunologia , Pneumonia Viral/metabolismo
10.
Medicine (Baltimore) ; 99(26): e20763, 2020 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-32590752

RESUMO

Several previous studies have reported that physical activity (PA) levels can independently affect the prevalence of gallstone disease (GD) in Western countries. However, this association has not been reported in Eastern countries. Therefore, this study aimed to determine whether PA is an independent determinant of GD prevalence in a Korean population, according to the World Health Organizations Global Recommendations on PA for Health.A total of 8908 subjects who completed a questionnaire underwent medical examination and ultrasound scanning at the Health Promotion Center of the Jeju National University Hospital between January 2009 and December 2018. GD and fatty liver disease were diagnosed by abdominal ultrasound. Biochemical parameters and body mass index were determined, and metabolic syndrome status, age, and PA levels were extracted from medical records. Univariate and multivariate analyses were performed to identify independent factors affecting GD.The estimated rates of PA and GD among male subjects were 23.7% and 4.6%, whereas the rates among females were 18.4% and 4.2%, respectively. Multivariate analysis suggested that no PA, old age, and higher aspartate aminotransferase level in males and nonalcoholic fatty liver disease status in females were independent factors affecting GD.In our study, PA was associated with a reduction in GD among males but not females.


Assuntos
Exercício Físico/fisiologia , Cálculos Biliares , Hepatopatia Gordurosa não Alcoólica , Fatores Sexuais , Fatores Etários , Índice de Massa Corporal , Feminino , Cálculos Biliares/sangue , Cálculos Biliares/diagnóstico por imagem , Cálculos Biliares/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/diagnóstico , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Prevalência , Fatores de Proteção , República da Coreia/epidemiologia , Fatores de Risco , Ultrassonografia/métodos
11.
Medicine (Baltimore) ; 99(26): e20898, 2020 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-32590801

RESUMO

This study was performed to explore the relationship between coronary heart disease (CHD) and nonalcoholic fatty liver disease (NAFLD) in patients without hypertension and diabetes with a focus on predicting CHD.In total, 78 consecutive patients without hypertension and diabetes who were suspected of CHD underwent coronary angiography (CAG) or computed tomography CAG. They were segregated into the CHD and non-CHD group according to the CAG or computed tomography angiography results. The Gensini score was calculated based on CAG results in the CHD group. All patients underwent ultrasonographic measurement of the liver, subcutaneous fat, and visceral fat thickness.The CHD and the Gensini score were significantly correlated with V1, V2, and NAFLD. As the grade of NAFLD increases, the Gensini score was increased. After correcting for confounding factors, NAFLD (B = 2.474, P < .001, 95% confidence interval: 3.32-42.406) and cholesterol (B = 1.176, P = 0.025, 95% confidence interval: 1.155-9.101) were predictor for CHD.The CHD is associated with NAFLD in the patients without hypertension and diabetes. The high-grade NAFLD may be predicted the risk of CHD in patients without hypertension and diabetes.


Assuntos
Doença das Coronárias/complicações , Hepatopatia Gordurosa não Alcoólica/etiologia , Adulto , Idoso , China/epidemiologia , Doença das Coronárias/epidemiologia , Doença das Coronárias/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Hepatopatia Gordurosa não Alcoólica/fisiopatologia , Estudos Prospectivos , Fatores de Risco , Ultrassonografia/métodos
12.
Cardiovasc Diabetol ; 19(1): 51, 2020 05 02.
Artigo em Inglês | MEDLINE | ID: mdl-32359355

RESUMO

BACKGROUND: Despite the known association between non-alcoholic fatty liver disease (NAFLD) and cardiovascular disease (CVD), whether NAFLD predicts future CVD events, especially CVD mortality, remains uncertain. We evaluated the relationship between fatty liver index (FLI), a validated marker of NAFLD, and risk of major adverse cardiac events (MACEs) in a large population-based study. METHODS: We identified 3011,588 subjects in the Korean National Health Insurance System cohort without a history of CVD who underwent health examinations from 2009 to 2011. The primary endpoint was a composite of cardiovascular deaths, non-fatal myocardial infarction (MI), and ischemic stroke. A Cox proportional hazards regression analysis was performed to assess association between the FLI and the primary endpoint. RESULTS: During the median follow-up period of 6 years, there were 46,010 cases of MACEs (7148 cases of cardiovascular death, 16,574 of non-fatal MI, and 22,288 of ischemic stroke). There was a linear association between higher FLI values and higher incidence of the primary endpoint. In the multivariable models adjusted for factors, such as body weight and cholesterol levels, the hazard ratio for the primary endpoint comparing the highest vs. lowest quartiles of the FLI was 1.99 (95% confidence interval [CIs], 1.91-2.07). The corresponding hazard ratios (95% CIs) for cardiovascular death, non-fetal MI, and ischemic stroke were 1.98 (1.9-2.06), 2.16 (2.01-2.31), and 2.01 (1.90-2.13), respectively (p < 0.001). The results were similar when we performed stratified analyses by age, sex, use of dyslipidemia medication, obesity, diabetes, and hypertension. CONCLUSIONS: Our findings indicate that the FLI, which is a surrogate marker of NAFLD, has prognostic value for detecting individuals at higher risk for cardiovascular events.


Assuntos
Doenças Cardiovasculares/epidemiologia , Hepatopatia Gordurosa não Alcoólica/diagnóstico , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Adulto , Doenças Cardiovasculares/diagnóstico , Bases de Dados Factuais , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , República da Coreia/epidemiologia , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo
13.
Lancet Gastroenterol Hepatol ; 5(8): 739-752, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32413340

RESUMO

BACKGROUND: Although non-alcoholic fatty liver disease (NAFLD) is commonly associated with obesity, it is increasingly being identified in non-obese individuals. We aimed to characterise the prevalence, incidence, and long-term outcomes of non-obese or lean NAFLD at a global level. METHODS: For this systematic review and meta-analysis, we searched PubMed, Embase, Scopus, and the Cochrane Library from inception to May 1, 2019, for relevant original research articles without any language restrictions. The literature search and data extraction were done independently by two investigators. Primary outcomes were the prevalence of non-obese or lean people within the NAFLD group and the prevalence of non-obese or lean NAFLD in the general, non-obese, and lean populations; the incidence of NAFLD among non-obese and lean populations; and long-term outcomes of non-obese people with NAFLD. We also aimed to characterise the demographic, clinical, and histological characteristics of individuals with non-obese NAFLD. FINDINGS: We identified 93 studies (n=10 576 383) from 24 countries or areas: 84 studies (n=10 530 308) were used for the prevalence analysis, five (n=9121) were used for the incidence analysis, and eight (n=36 954) were used for the outcomes analysis. Within the NAFLD population, 19·2% (95% CI 15·9-23·0) of people were lean and 40·8% (36·6-45·1) were non-obese. The prevalence of non-obese NAFLD in the general population varied from 25% or lower in some countries (eg, Malaysia and Pakistan) to higher than 50% in others (eg, Austria, Mexico, and Sweden). In the general population (comprising individuals with and without NAFLD), 12·1% (95% CI 9·3-15·6) of people had non-obese NAFLD and 5·1% (3·7-7·0) had lean NAFLD. The incidence of NAFLD in the non-obese population (without NAFLD at baseline) was 24·6 (95% CI 13·4-39·2) per 1000 person-years. Among people with non-obese or lean NALFD, 39·0% (95% CI 24·1-56·3) had non-alcoholic steatohepatitis, 29·2% (21·9-37·9) had significant fibrosis (stage ≥2), and 3·2% (1·5-5·7) had cirrhosis. Among the non-obese or lean NAFLD population, the incidence of all-cause mortality was 12·1 (95% CI 0·5-38·8) per 1000 person-years, that for liver-related mortality was 4·1 (1·9-7·1) per 1000 person-years, cardiovascular-related mortality was 4·0 (0·1-14·9) per 1000 person-years, new-onset diabetes was 12·6 (8·0-18·3) per 1000 person-years, new-onset cardiovascular disease was 18·7 (9·2-31·2) per 1000 person-years, and new-onset hypertension was 56·1 (38·5-77·0) per 1000 person-years. Most analyses were characterised by high heterogeneity. INTERPRETATION: Overall, around 40% of the global NAFLD population was classified as non-obese and almost a fifth was lean. Both non-obese and lean groups had substantial long-term liver and non-liver comorbidities. These findings suggest that obesity should not be the sole criterion for NAFLD screening. Moreover, clinical trials of treatments for NAFLD should include participants across all body-mass index ranges. FUNDING: None.


Assuntos
Hepatopatia Gordurosa não Alcoólica/epidemiologia , Hepatopatia Gordurosa não Alcoólica/mortalidade , Obesidade/complicações , Magreza/epidemiologia , Adulto , Índice de Massa Corporal , Doenças Cardiovasculares/epidemiologia , Estudos de Casos e Controles , Comorbidade , Diabetes Mellitus/epidemiologia , Feminino , Fibrose/classificação , Fibrose/epidemiologia , Humanos , Hipertensão/epidemiologia , Incidência , Masculino , Programas de Rastreamento/normas , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/complicações , Hepatopatia Gordurosa não Alcoólica/patologia , Avaliação de Resultados em Cuidados de Saúde , Prevalência
14.
Medicine (Baltimore) ; 99(19): e20148, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32384501

RESUMO

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is strongly associated with type 2 diabetes mellitus (T2DM), and low vitamin D levels are positively associated with NAFLD and T2DM. But there is absence of convincing evidence-based medicine to confirm the efficacy of vitamin D supplementation for T2DM with NAFLD. Thus, we aimed to conduct this meta-analysis to summarize the efficacy of vitamin D supplementation for T2DM combined with NAFLD, and help to further clarify its beneficial action on diabetic patients with NAFLD. METHODS: The study only selects clinical randomized controlled trials of vitamin D supplementation for T2DM combined with NAFLD. We will search each database from the built-in until July 2020. The English literature mainly searches Cochrane Library, Pubmed, EMBASE, and Web of Science. While the Chinese literature comes from CNKI, CBM, VIP, and Wangfang database. Meanwhile, we will retrieve clinical trial registries and grey literature. Two researchers worked independently on literature selection, data extraction, and quality assessment. The dichotomous data is represented by relative risk (RR), and the continuous is expressed by mean difference (MD) or standard mean difference (SMD), eventually the data is synthesized using a fixed effect model (FEM) or a random effect model (REM) depending on the heterogeneity. The imaging markers of liver, biomarkers of hepatic steatosis, serological indexes of hepatic fibrosis, serum NAFLD liver fat score were evaluated as the main outcomes. While several secondary outcomes were also evaluated in this study. The statistical analysis of this meta-analysis was conducted by RevMan software version 5.3. RESULTS: This meta-analysis will further determine the beneficial efficacy of vitamin D supplementation for T2DM combined with NAFLD. CONCLUSION: This study determines the positive efficacy of vitamin D supplementation for diabetic patients with NAFLD.


Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/epidemiologia , Suplementos Nutricionais , Hepatopatia Gordurosa não Alcoólica/tratamento farmacológico , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Vitamina D/uso terapêutico , Biomarcadores , Humanos , Testes de Função Hepática , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa
15.
Nat Commun ; 11(1): 2111, 2020 04 30.
Artigo em Inglês | MEDLINE | ID: mdl-32355283

RESUMO

Preterm birth (PTB) is the leading cause of perinatal mortality and newborn complications. Bile acids are recognized as signaling molecules regulating a myriad of cellular and metabolic activities but have not been etiologically linked to PTB. In this study, a hospital-based cohort study with 36,755 pregnant women is conducted. We find that serum total bile acid levels directly correlate with the PTB rates regardless of the characteristics of the subjects and etiologies of liver disorders. Consistent with the findings from pregnant women, PTB is successfully reproduced in mice with liver injuries and dysregulated bile acids. More importantly, bile acids dose-dependently induce PTB with minimal hepatotoxicity. Furthermore, restoring bile acid homeostasis by farnesoid X receptor activation markedly reduces PTB and dramatically improves newborn survival rates. The findings thus establish an etiologic link between bile acids and PTB, and open an avenue for developing etiology-based therapies to prevent or delay PTB.


Assuntos
Ácidos e Sais Biliares/sangue , Nascimento Prematuro/epidemiologia , Adolescente , Adulto , Animais , Tetracloreto de Carbono , Ácido Cólico/metabolismo , Modelos Animais de Doenças , Feminino , Hospitais , Humanos , Recém-Nascido , Hepatopatias/epidemiologia , Masculino , Camundongos , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Gravidez , Resultado da Gravidez , Prenhez , Nascimento Prematuro/sangue , Estudos Prospectivos , Transdução de Sinais , Adulto Jovem
16.
PLoS Med ; 17(4): e1003100, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32353039

RESUMO

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is a leading cause of chronic liver disease worldwide. Many individuals have risk factors associated with NAFLD, but the majority do not develop advanced liver disease: cirrhosis, hepatic decompensation, or hepatocellular carcinoma. Identifying people at high risk of experiencing these complications is important in order to prevent disease progression. This review synthesises the evidence on metabolic risk factors and their potential to predict liver disease outcomes in the general population at risk of NAFLD or with diagnosed NAFLD. METHODS AND FINDINGS: We conducted a systematic review and meta-analysis of population-based cohort studies. Databases (including MEDLINE, EMBASE, the Cochrane Library, and ClinicalTrials.gov) were searched up to 9 January 2020. Studies were included that reported severe liver disease outcomes (defined as liver cirrhosis, complications of cirrhosis, or liver-related death) or advanced fibrosis/non-alcoholic steatohepatitis (NASH) in adult individuals with metabolic risk factors, compared with individuals with no metabolic risk factors. Cohorts selected on the basis of a clinically indicated liver biopsy were excluded to better reflect general population risk. Risk of bias was assessed using the QUIPS tool. The results of similar studies were pooled, and overall estimates of hazard ratio (HR) were obtained using random-effects meta-analyses. Of 7,300 unique citations, 22 studies met the inclusion criteria and were of sufficient quality, with 18 studies contributing data suitable for pooling in 2 random-effects meta-analyses. Type 2 diabetes mellitus (T2DM) was associated with an increased risk of incident severe liver disease events (adjusted HR 2.25, 95% CI 1.83-2.76, p < 0.001, I2 99%). T2DM data were from 12 studies, with 22.8 million individuals followed up for a median of 10 years (IQR 6.4 to 16.9) experiencing 72,792 liver events. Fourteen studies were included in the meta-analysis of obesity (BMI > 30 kg/m2) as a prognostic factor, providing data on 19.3 million individuals followed up for a median of 13.8 years (IQR 9.0 to 19.8) experiencing 49,541 liver events. Obesity was associated with a modest increase in risk of incident severe liver disease outcomes (adjusted HR 1.20, 95% CI 1.12-1.28, p < 0.001, I2 87%). There was also evidence to suggest that lipid abnormalities (low high-density lipoprotein and high triglycerides) and hypertension were both independently associated with incident severe liver disease. Significant study heterogeneity observed in the meta-analyses and possible under-publishing of smaller negative studies are acknowledged to be limitations, as well as the potential effect of competing risks on outcome. CONCLUSIONS: In this review, we observed that T2DM is associated with a greater than 2-fold increase in the risk of developing severe liver disease. As the incidence of diabetes and obesity continue to rise, using these findings to improve case finding for people at high risk of liver disease will allow for effective management to help address the increasing morbidity and mortality from liver disease. TRIAL REGISTRATION: PROSPERO CRD42018115459.


Assuntos
Doenças Metabólicas/epidemiologia , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Estudos Observacionais como Assunto/métodos , Vigilância da População , Humanos , Incidência , Hepatopatias/sangue , Hepatopatias/diagnóstico , Hepatopatias/epidemiologia , Doenças Metabólicas/sangue , Doenças Metabólicas/diagnóstico , Hepatopatia Gordurosa não Alcoólica/sangue , Hepatopatia Gordurosa não Alcoólica/diagnóstico , Vigilância da População/métodos , Fatores de Risco
17.
Am J Med Sci ; 360(2): 161-165, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32448495

RESUMO

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is regarded as a feature of metabolic syndrome in the liver. Metabolic syndrome is associated with a higher risk of bladder cancer. However, the association between NAFLD and bladder cancer is unclear. We aimed to investigate the association between NAFLD and bladder cancer. MATERIALS AND METHODS: The records of all patients (n = 251) diagnosed with the bladder cancer in our hospital between 2009 and 2013 were reviewed. We also randomly collected the records of adults without cancer (n = 266) as the control group. Clinical characteristics, biochemical tests for liver and metabolic function and abdominal computed tomography were assessed. RESULTS: The incidence of NAFLD was 12.0% in the bladder cancer group and 4.9% in the control group. By multiple logistic regression analysis, NAFLD (P = 0.007; odds ratio [OR]: 2.61; 95% confidence interval [CI]: 1.30-5.22), male sex (P < 0.001; OR: 2.34; 95% CI: 1.61-3.41) and use of lipid lowering drugs (P = 0.001; OR: 0.43; 95% CI: 0.26-0.72) showed significant associations with bladder cancer. In bladder cancer patients, the median survival time was significantly longer in patients without NAFLD than in these with NAFLD (40 months versus 21.5 months, P = 0.022). CONCLUSIONS: NAFLD was positively associated with bladder cancer and was a poor prognostic factor of bladder cancer. Further studies are needed to confirm whether NAFLD is a factor for the development of bladder cancer.


Assuntos
Carcinoma de Células de Transição/epidemiologia , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Neoplasias da Bexiga Urinária/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Hipolipemiantes/uso terapêutico , Modelos Logísticos , Masculino , Síndrome Metabólica/epidemiologia , Pessoa de Meia-Idade , Razão de Chances , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Taxa de Sobrevida , Taiwan/epidemiologia
18.
Am J Gastroenterol ; 115(8): 1289-1292, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32453041

RESUMO

INTRODUCTION: We investigated the longitudinal impact of antinuclear antibody (ANA) on clinical outcomes and survival in nonalcoholic fatty liver disease (NAFLD). METHODS: ANA were found in 16.9% of 923 biopsy-proven NAFLD patients, but none of them had histologic autoimmune hepatitis (AIH) or developed AIH after a mean follow-up of 106±50 months. RESULTS: Although ANA-positive cases had a higher prevalence of nonalcoholic steatohepatitis at baseline, the occurrence of liver-related events, hepatocellula carcinoma, cardiovascular events, extrahepatic malignancy, and overall survival were similar to ANA-negative. DISCUSSION: Once AIH has been ruled out, the long-term outcomes and survival are unaffected by the presence of ANA in patients with NAFLD.


Assuntos
Anticorpos Antinucleares/sangue , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Biópsia , Inglaterra/epidemiologia , Feminino , Humanos , Itália/epidemiologia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/sangue , Hepatopatia Gordurosa não Alcoólica/mortalidade , Hepatopatia Gordurosa não Alcoólica/patologia , Prevalência , Estudos Prospectivos , Análise de Sobrevida
19.
Nutr Metab Cardiovasc Dis ; 30(6): 1014-1022, 2020 06 09.
Artigo em Inglês | MEDLINE | ID: mdl-32423665

RESUMO

BACKGROUND AND AIMS: Nonalcoholic steatohepatitis (NASH) may progress to advanced liver disease (AdvLD). This study characterized comorbidities, healthcare resource utilization (HCRU) and associated costs among hospitalized patients with AdvLD due to NASH in Italy. METHODS AND RESULTS: Adult nonalcoholic fatty liver disease (NAFLD)/NASH patients from 2011 to 2017 were identified from administrative databases of Italian local health units using ICD-9-CM codes. Development of compensated cirrhosis (CC), decompensated cirrhosis (DCC), hepatocellular carcinoma (HCC), or liver transplant (LT) was identified using first diagnosis date for each severity cohort (index-date). Patients progressing to multiple disease stages were included in >1 cohort. Patients were followed from index-date until the earliest of disease progression, end of coverage, death, or end of study. Within each cohort, per member per month values were annualized to calculate all-cause HCRU or costs(€) in 2017. Of the 9,729 hospitalized NAFLD/NASH patients identified, 97% were without AdvLD, 1.3% had CC, 3.1% DCC, 0.8% HCC, 0.1% LT. Comorbidity burden was high across all cohorts. Mean annual number of inpatient services was greater in patients with AdvLD than without AdvLD. Similar trends were observed in outpatient visits and pharmacy fills. Mean total annual costs increased with disease severity, driven primarily by inpatient services costs. CONCLUSION: NAFLD/NASH patients in Italy have high comorbidity burden. AdvLD patients had significantly higher costs. The higher prevalence of DCC compared to CC in this population may suggest challenges of effectively screening and identifying NAFLD/NASH patients. Early identification and effective management are needed to reduce risk of disease progression and subsequent HCRU and costs.


Assuntos
Recursos em Saúde/economia , Custos Hospitalares , Hepatopatia Gordurosa não Alcoólica/economia , Hepatopatia Gordurosa não Alcoólica/terapia , Demandas Administrativas em Assistência à Saúde , Adolescente , Adulto , Idoso , Assistência Ambulatorial/economia , Carcinoma Hepatocelular/economia , Carcinoma Hepatocelular/epidemiologia , Carcinoma Hepatocelular/terapia , Comorbidade , Bases de Dados Factuais , Progressão da Doença , Custos de Medicamentos , Feminino , Recursos em Saúde/tendências , Custos Hospitalares/tendências , Humanos , Itália/epidemiologia , Cirrose Hepática/economia , Cirrose Hepática/epidemiologia , Cirrose Hepática/terapia , Neoplasias Hepáticas/economia , Neoplasias Hepáticas/epidemiologia , Neoplasias Hepáticas/terapia , Transplante de Fígado/economia , Masculino , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/diagnóstico , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Admissão do Paciente/economia , Prevalência , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Adulto Jovem
20.
Biomed Environ Sci ; 33(4): 217-226, 2020 Apr 20.
Artigo em Inglês | MEDLINE | ID: mdl-32438959

RESUMO

Objective: Liver fibrosis is an important predictor of mortality in nonalcoholic fatty liver disease (NAFLD). Peripheral artery disease (PAD) and liver fibrosis share many common metabolic dysfunctions. We aimed to explore the association between PAD and risk of fibrosis deterioration in NAFLD patients. Methods: The study recruited 1,610 NAFLD patients aged ≥ 40 years from a well-defined community at baseline in 2010 and followed up between August 2014 and May 2015. Fibrosis deterioration was defined as the NAFLD fibrosis score (NFS) status increased to a higher category at the follow-up visit. PAD was defined as an ankle-brachial index of < 0.90 or > 1.40. Results: During an average of 4.3 years' follow-up, 618 patients progressed to a higher NFS category. PAD was associated with 92% increased risk of fibrosis deterioration [multivariable-adjusted odds ratio ( OR): 1.92, 95% confidence interval ( CI): 1.24, 2.98]. When stratified by baseline NFS status, the OR for progression from low to intermediate or high NFS was 1.74 (95% CI: 1.02, 3.00), and progression from intermediate to high NFS was 2.24 (95% CI: 1.05, 4.80). There was a significant interaction between PAD and insulin resistance (IR) on fibrosis deterioration ( P for interaction = 0.03). As compared with non-PAD and non-IR, the coexistence of PAD and IR was associated with a 3.85-fold (95% CI: 2.06, 7.18) increased risk of fibrosis deterioration. Conclusion: PAD is associated with an increased risk of fibrosis deterioration in NAFLD patients, especially in those with IR. The coexistence of PAD and IR may impose an interactive effect on the risk of fibrosis deterioration.


Assuntos
Cirrose Hepática/epidemiologia , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Doença Arterial Periférica/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Índice Tornozelo-Braço , China/epidemiologia , Feminino , Humanos , Cirrose Hepática/etiologia , Masculino , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/etiologia , Prevalência , Estudos Prospectivos , Fatores de Risco
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