Prevalence of hepatic steatosis as assessed by controlled attenuation parameter (CAP) in subjects with metabolic risk factors in primary care. A population-based study.

BACKGROUND: Primary care is the ideal setting for early identification of patients with non-alcoholic fatty liver disease (NAFLD). NAFLD is a potentially progressive disease that may lead to cirrhosis and liver cancer but is frequently underrecognized because subjects at risk are often not evaluated. Controlled attenuation parameter (CAP) is a reliable method for non-invasive quantification of liver fat. It has the advantage of simultaneous measurement of liver stiffness (LS), an estimate of liver fibrosis. There is no information on CAP in subjects with risk factors from primary care. AIM: To investigate the prevalence of hepatic steatosis, as estimated by CAP, in subjects from the community with metabolic risk factors and correlate findings with clinical and biochemical characteristics and LS. PATIENTS AND METHODS: Population-based study of 215 subjects with metabolic risk factors without known liver disease identified randomly from a primary care center. A control group of 80 subjects matched by age and sex without metabolic risk factors was also studied. CAP and LS were assessed using Fibroscan. RESULTS: Subjects with risk factors had CAP values higher than those of control group (268±64 vs 243±49dB/m,p<0.001). Prevalence of severe steatosis (CAP> 280dB/m) in subjects with risk factors was 43%. In multivariate analysis, fatty liver index (FLI) and HOMA were independent predictive factors of severe steatosis. There was a direct correlation between CAP and FLI values (r = 0.52,p<0.001). Interestingly, prevalence of increased LS was 12.6% in the risk group vs 0% in the control group (p<0.001). Increased LS occurred predominantly in subjects with high CAP values. CONCLUSIONS: A high proportion of subjects with metabolic risk factors seen in primary care have severe steatosis. FLI could be used as a surrogate of CAP. Increased LS was found in a significant proportion of subjects with risk factors but not in control subjects.

Pre-participation medical evaluation in competitive athletes: the experience of an international multisport club

Objective: to assess the effectiveness of a tailored Pre-Participation Medical Examination (PPME) prior to sport practice for athletes competing in team sports, has been suggested as a useful tool for an early identification and treatment of multiple disorders. Design: Among 2008 and 2018 a total of 2570 athletes from 12 to 35 years old from 12 different team sports disciplines were evaluated by the PPME of Football Club Barcelona. Methods: The PPME included: medical history, anthropometric data, physical examination, baseline 12-lead ECG, a maximal stress test, a 2D-Doppler chocardiography and an extensive orthopaedic evaluation. Results: In 495 of the 2574 athletes (19.2%), the PPME identified pathologies that require a specific treatment or a closed follow-up. The most frequent medical conditions documented in young athletes were neurological, psychological and psychiatric disorders whereas in adults the most prevalent were respiratory and immunological pathologies. Two athletes were considered inadequate to compete due to severe cardiovascular diseases whereas seven required a specific treatment for their cardiovascular diseases in order to be considered eligible for sports competition. Additionally, a large proportion of athletes (958, 37.2%) reported previous musculoskeletal sport-related injuries being bone fractures and joint injuries the most frequent ones.Conclusions: The Football Club Barcelona PPME was effective in identifying latent pathologies and musculoskeletal sport-related injuries in a significant proportion of young and adult athletes competing in team sports. The identification of these medical conditions allowed to provide an early and specific treatment and to implement strategic ad hoc preventive programs.