Prevalence Of Nonalcoholic Fatty Liver Disease In Patients Research Articles

Prevalence of nonalcoholic fatty liver disease in Pakistan: a systematic review and meta-analysis

Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver condition globally and the leading cause of liver-related death and morbidity. The goal of this study was to collect current data in order to calculate the pooled prevalence of NAFLD in Pakistan. We conducted a comprehensive literature search on four electronic databases until March 2024 to find studies on the prevalence of NAFLD in Pakistan. Pooled prevalence estimates of NAFLD were obtained using random-effects meta-analytic models. The chi-square test was used to account for study heterogeneity, whereas the I2 statistic was used to assess inconsistency. The data were stratified by the general population (average risk) and individuals with metabolic diseases (high risk). Two reviewers thoroughly and independently screened, reviewed, and assessed all studies. In total, 468 studies were reviewed, and 34 were included. The pooled NAFLD prevalence in the general population was 29.82% (95% CI 21.39–39.01%; prediction interval: 2.98–68.92%) based on 13 studies. In individuals with metabolic disorders, the prevalence of NAFLD in patients with diabetes, hypertension, and obesity, was 58.47% (95% CI 54.23–62.64%; prediction interval: 38.16–77.40%), 74.08% (95% CI 60.50–85.70%), and 47.43% (95% CI 30.49–64.66%), respectively. There was no evidence of publication bias, although a statistically significant level of heterogeneity was seen among the studies (I2 ranged from 57.5 to 98.69%). The findings of this study indicate a substantial prevalence of NAFLD in the population of Pakistan. The Pakistani government must formulate a comprehensive approach and plan aimed at augmenting awareness, control, prevention, and treatment of fatty liver disease.Prospero Registration no: CRD42022356607.

Prevalence of Non-Alcoholic Fatty Liver Disease and Its Impact on Fibrosis Risk in Inactive Chronic Hepatitis B Patients: Insights from a Cross-Sectional Study.

Background: Chronic hepatitis B (CHB) and non-alcoholic fatty liver disease (NAFLD) are significant causes of chronic liver disease, potentially leading to liver cirrhosis and hepatocellular carcinoma. Moreover, the coexistence of CHB and NAFLD is increasingly common, although the relationship between NAFLD and inactive CHB infection remains poorly understood. Objectives: This study aimed to investigate the prevalence of NAFLD among patients with inactive CHB, identify risk factors for NAFLD, and determine predictors of significant fibrosis in these patients. Methods: This single-center cross-sectional study targeted patients with inactive CHB at Sultan Qaboos University Hospital from January 2010 to November 2021. Results: A total of 425 patients with inactive CHB were identified, of which 53.1% were male and 62.6% were aged 40-60 years. The prevalence of NAFLD was 47.8%. Various independent factors were associated with NAFLD, including type 2 diabetes mellitus, elevated low-density lipoprotein levels, high hemoglobin levels, low platelet counts, and normal alpha-fetoprotein levels. Significant associations were noted between NAFLD and significant fibrosis, with 10.5% of CHB patients with NAFLD exhibiting significant fibrosis compared to 1.4% of those without NAFLD. Other significant parameters included male gender, increased age, high alanine transaminase levels, elevated hemoglobin, and decreased platelet levels. Conclusions: The high prevalence of NAFLD in patients with inactive CHB and its associations with increased fibrosis and cirrhosis risk underscore the need for comprehensive management strategies for these patients.

Hypogonadism and nonalcoholic fatty liver disease.

Nonalcoholic fatty liver disease (NAFLD), recently proposed to be renamed to metabolic dysfunction-associated steatotic liver disease (MASLD), is a major global public health concern, affecting approximately 25-30% of the adult population and possibly leading to cirrhosis, hepatocellular carcinoma, and liver transplantation. The liver is involved in the actions of sex steroids via their hepatic metabolism and production of the sex hormone-binding globulin (SHBG). Liver disease, including NAFLD, is associated with reproductive dysfunction in men and women, and the prevalence of NAFLD in patients with hypogonadism is considerable. A wide spectrum of possible pathophysiological mechanisms linking NAFLD and male/female hypogonadism has been investigated. As therapies targeting NAFLD may impact hypogonadism in men and women, and vice versa, treatments of the latter may affect NAFLD, and an insight into their pathophysiological pathways is imperative. This paper aims to elucidate the complex association between NAFLD and hypogonadism in men and women and discuss the therapeutic options and their impact on both conditions.

Risk Factors for Non-Alcoholic Fatty Liver Disease in Patients with Bipolar Disorder: A Cross-Sectional Retrospective Study.

The co-morbidity of non-alcoholic fatty liver disease (NAFLD) in patients with bipolar disorder (BD) has a negative impact on patient treatment and prognosis. This study aimed to identify the prevalence of NAFLD in patients with BD and investigate the risk factors of NAFLD. A total of 678 patients with BD were included in the study. Clinical data were obtained from the hospital's electronic health record system. Data included fasting blood glucose, alanine aminotransferase, triglycerides, aspartate aminotransferase, high-density lipoprotein cholesterol (HDL), alkaline phosphatase, total cholesterol, glutamine transpeptidase, uric acid, apolipoprotein A1, apolipoprotein B, and liver ultrasound findings. The prevalence of NAFLD was 43.66% in patients with BD. Significant differences in body mass index (BMI), mean age, diabetes prevalence, course of BD, fasting blood glucose, alanine aminotransferase, HDL, alkaline phosphatase, triglycerides, aspartate aminotransferase, uric acid, glutamine transpeptidase, apolipoprotein B, total cholesterol, and apolipoprotein A1 were seen between the groups (all P<0.01). Male sex, age, BMI, course of BD, alanine aminotransferase, fasting blood glucose, aspartate aminotransferase, diabetes, glutamine transpeptidase, total cholesterol, alkaline phosphatase, triglycerides, uric acid, apolipoprotein B, HDL, and apolipoprotein A1 levels were correlated with NAFLD (all P<0.05). In patients with BD, diabetes (OR=6.412, 95% CI=1.049-39.21), BMI (OR=1.398, 95% CI=1.306-1.497), triglycerides (OR=1.456, 95% CI=1.036-2.045), and apolipoprotein A1 (OR=0.272, 95% CI=0.110-0.672) were risk factors for NAFLD (all P<0.05). Risk factors for NAFLD in patients with BD include diabetes, BMI, course of BD, and a low level of apolipoprotein A1. A proactive approach to disease management, such as appropriate physical activity and adoption of a healthy diet, and regular monitoring of changes in patient markers should be adopted to reduce the prevalence of NAFLD.

THU072 Association Between Nonalcoholic Fatty Liver Disease And Growth Hormone Deficiency In Patients With Nonfunctioning Pituitary Adenoma

Abstract Disclosure: Y. Hwang: None. H. Lee: None. S. Ahn: None. E. Lee: None. C. Ku: None. S. Kim: None. Objective: We investigated the association between nonalcoholic fatty liver disease (NAFLD) and growth hormone deficiency (GHD) in patients with non-functioning pituitary adenoma (NFPA). Methods: Patients with NFPA who underwent transsphenoidal adenectomy between January 2005 and December 2018 were recruited. Pituitary function was determined by the insulin tolerance test, thyroid hormone assay, and gonadal hormone levels. NAFLD was defined as a hepatic steatosis index greater than 36. Results: 278 patients were included for the analysis. Mean age was 44.2 years and 58.6%[n=163] patients were female. Among 278 patients,103 (37.0%) had GHD, 139 (50.0%) had hypogonadism. 75 out of 278 patients (27.0%) had NAFLD. The prevalence of NAFLD was significantly higher in patients with GHD than in those without (36.9% vs. 21.1%, p=0.01). Even after adjusting for age, total cholesterol level, gonadal function, and prolactin level, patients with GHD had approximately two-fold higher prevalence of NALFD than those without GHD (adjusted odds ratio [OR]=1.85, 95% confidence interval [CI]=1.05-3.28, p=0.03). Among female patients, the prevalence of NALFD was significantly higher in those with GHD than in those without (adjusted OR=2.39, 95% CI=1.03-5.55, p=0.04). On the other hand, the prevalence of NAFLD among male patients was statistically similar between patients with and without GHD (p&amp;gt;0.05). In addition, gonadal function did not affect the prevalence of NAFLD in patients with NFPA (29.3% with eugonadism vs. 47.8% with hypogonadism, p=0.14). Conclusion: The prevalence of NAFLD among patients with NFPA was twice as high as among patients without GHD. Thus, screening for NAFLD may be necessary in NFPA patients with GHD. Presentation: Thursday, June 15, 2023

NAFLD is associated with less severe liver fibrosis in chronic hepatitis B: A multi-center, retrospective study

Introduction and ObjectivesChronic hepatitis B (CHB) may progress to more serious liver diseases and it is often accompanied by non-alcoholic fatty liver disease (NAFLD). NAFLD and CHB share risk factors for liver fibrosis and cirrhosis, but the influence of NAFLD on fibrosis progression is controversial. This retrospective study evaluated the prevalence of NAFLD in patients with CHB and investigated associations between NAFLD and liver fibrosis in a large multi-center cohort of hepatitis B patients submitted to liver biopsy. Patients and MethodsTreatment-naïve patients with CHB who underwent liver biopsy were analyzed. Propensity score matching (PSM) was performed to adjust the confounders between patients with and without NAFLD. ResultsA total of 1496 CHB patients were included. Two hundred and ninety (19.4%) patients were diagnosed with NAFLD by liver biopsy. The proportions of significant liver fibrosis (52.8% vs. 63.9%, P<0.001), advanced liver fibrosis (27.2% vs. 36.5%, P=0.003), and cirrhosis (13.4% vs. 19.7%, P=0.013) was considerably lower in CHB patients with NAFLD compared to those without NAFLD. 273 patients were included in each group after PSM adjusted for age, sex, hepatitis B envelope antigen status, and hepatitis B virus DNA. Liver fibrosis remained less severe in CHB patients with NAFLD than those without NAFLD (P<0.05) after PSM. The presence of NAFLD was considered an independent negative factor of significant liver fibrosis (odds ratio (OR) 0.692, P=0.013) and advanced liver fibrosis (OR 0.533, P = 0.002) in CHB patients. ConclusionsNAFLD is not uncommon in CHB patients with the prevalence of 19.4%. The presence of NAFLD is associated with less severe liver fibrosis in CHB patients. Registration No. of the study/trialNCT03097952.

Prevalence and associated factors for non-alcoholic fatty liverdisease among adults in the South Asian Region: a meta-analysis.

Non-alcoholic fatty liver disease (NAFLD) is the commonest chronic liver disease worldwide. We estimated the prevalence and predefined associated factors for NAFLD among South-Asian adults. We searched PubMed and included descriptive, epidemiological studies with satisfactory methodology, reporting the prevalence of NAFLD with ultrasound. Two authors screened and extracted data independently. Gender, urban/rural settings, general population and individuals with metabolic diseases (MetD) stratified the analysis. In addition, a random-effects meta-analysis of the prevalence and effect sizes of associations of NAFLD was performed. Twenty-two publications were included after the quality assurance process. The difference in the NAFLD prevalence between the general population and people with MetD was found to be statistically significant (Q=15.8, DF=1, P<0.001). The pooled overall prevalence of NAFLD in the general population was 26.9% (95% CI: 18.9-35.8%) with high heterogeneity. The prevalence was similar among men and women (Q=0.06, DF=1, P=0.806). The NAFLD prevalence in the rural communities was 22.6% (95% CI: 13.6-33.1%), and the prevalence in urban communities was 32.9% (95% CI: 22.8-43.8%) and the difference was not statistically significant (Q=1.92, DF=1, P=0.166). The pooled overall prevalence of NAFLD in patients with MetD was 54.1% (95% CI: 44.1-63.9%) with high heterogeneity. The pooled overall prevalence of NAFLD in the non-obese population was 11.7% (95% CI: 7.0-17.3%). The pooled prevalence of non-obese NAFLD in the NAFLD population was 43.4% (95% CI: 28.1-59.4%). Meta-analysis of binary variables showed that NAFLD in the South Asian population was associated with diabetes mellitus, hypertension, dyslipidaemia, general obesity, central obesity and metabolic syndrome. Gender was not associated with NAFLD. The overall prevalence of NAFLD among adults in South Asia is high, especially in those with MetD, and a considerable proportion is non-obese. In the South Asian population, NAFLD was associated with diabetes mellitus, hypertension, dyslipidaemia, general obesity, central obesity, and metabolic syndrome. None.

Hepatic Steatosis but Not Fibrosis Is Independently Associated with Poor Outcomes in Patients with Inflammatory Bowel Disease.

Increased prevalence of nonalcoholic fatty liver disease (NAFLD) and inflammatory bowel disease (IBD) has been reported. However, the effects of NAFLD on the outcome of IBD remains unclear. We investigated whether the presence of NAFLD could influence the outcomes of patients with IBD. We recruited 3,356 eligible patients with IBD into our study between November 2005 and November 2020. Hepatic steatosis and fibrosis were diagnosed using hepatic steatosis index of ≥30 and fibrosis-4 of ≥1.45, respectively. The primary outcome was clinical relapse, defined based on the following: IBD-related admission, surgery, or first use of corticosteroids, immunomodulators, or biologic agents for IBD. The prevalence of NAFLD in patients with IBD was 16.7%. Patients with hepatic steatosis and advanced fibrosis were older, had a higher body mass index, and were more likely to have diabetes (all p<0.05). Hepatic steatosis was independently associated with increased risks of clinical relapse in patients with ulcerative colitis and Crohn's disease, whereas fibrotic burden in the liver was not. Future studies should investigate whether assessment and therapeutic intervention for NAFLD will improve the clinical outcomes of patients with IBD.

STUDY OF RADIOLOGICAL, ANTHROPOMETRIC AND BIOCHEMICAL ASSESSMENT OF NAFLD IN TYPE 2 DIABETES MELLITUS IN WESTERN UTTAR PRADESH

Background: Type 2 diabetes mellitus (DM) might increase risk of Nonalcoholic fatty liver disease (NAFLD) though its prevalence is not well studied. Undiagnosed patients of NAFLD may progress to Chronic Liver disease and cirrhosis of liver with resultant increased morbidity and mortality. We conducted a prospective study of the prevalence of NAFLD in patients with type 2 DM and its relation with radiological, biochemical, and anthropometric parameters. Materials and Methods: 100 patients of Type 2DM diagnosed on the basis of ADA criteria attending Tertiary care centre in Western Uttar Pradesh were evaluated. Abdominal ultrasonography was performed to determine the presence of fatty liver. HbA1c, Liver function prole and Lipid Prole was done. A probability value of P &lt; 0.05 was considered statistically signicant. The study group (n = 100) was divided into a NAFLD group Results: (n = 61) and a non-NAFLD group (n = 39). The prevalence of NAFLD was 61%. There was positive correlation between glycated haemoglobin and NAFLD with higher levels of HbA1C correlating with incremental prevalence in NAFLD. Similarly there was a highly signicant association of BMI and NAFLD in our study population. The prevalence of NAFLD is high in patients of uncontrolled Type 2 DM. Conclusion: It correlates with higher HbA1c and BMI. So routine screening of Type 2 DM patients for NAFLD by ultrasonography of the liver may be helpful in monitoring the progression as well as treatment of the patients

P213 High prevalence and risk factors for nonalcoholic fatty liver disease in patients with Crohn's disease

Abstract Background Prevalence of Non-Alcoholic Fatty Liver Disease (NAFLD) is increasing in patients with Inflammatory Bowel Disease (IBD), particularly Crohn's Disease (CD). Despite this, the mechanisms and risk factors of NAFLD in IBD are still poorly understood and controversial. The aim of this study was to assess the prevalence and risk factors for NAFLD in patients with CD. Methods Prospective study conducted among consecutive patients with CD and treated at the Inflammatory Bowel Diseases outpatient clinic at University Hospital between July 2021 and May 2022. Demographic, anthropometric and CD characteristics, food intake, previous and current medications, pre-existing diseases, laboratory tests, plasma levels of trimethylamine oxide (TMAO) data were collected. All participants underwent ultrasound (US) of the upper abdomen for evaluation and classification of NAFLD. Results One hudndred and three patients with a mean age of 45.2 ± 15.0 years, 35.9% (n=37) were male. The prevalence of NAFLD was 40.8% (n=42) and overweight (BMI&amp;gt;25kg/m²) was present in 62.1%. Other associated diseases were present among NAFLD patients: systemic arterial hypertension (SAH) 4.9% (p&amp;lt;0,001), dyslipidemia 11.9% (p=0,040) and diabetes (DM) 19% (p=0,009). There were no statistically significant differences between CD characteristics or activity, previous or current CD treatment and food consumption with NAFLD. The presence of comorbidities such as SAH, DM and dyslipidemia, anthropometric markers such as Body Mass Index (BMI), waist circumference (AC), sagittal abdominal diameter (SAD), laboratory tests such as C-reactive protein (CRP), triglycerides (TG) and Liver enzymes were positively associated with the diagnosis of NAFLD. Plasma levels of TMAO showed no significant association with the presence of NAFLD and with CD activity but correlated with SAD (p 0,047). After adjusting for the multivariate model, only the variables SAH (p 0,046), DM (p 0,017), active CD (p 0,023), overweight (p 0,025) and obesity (p&amp;lt;0,001) remained associated to the presence of NAFLD. Conclusion The prevalence of NAFLD in patients with CD was 40.8%, higher than the global prevalence. The main risk factors for NAFLD in this population were like those in the general population such as systemic arterial hypertension, diabetes, dyslipidemia, visceral fat by sagittal abdominal diameter, overweight and obesity. The characteristics of CD, nutrient intake, and plasma levels of TMAO showed no relation with the presence of NAFLD. Crohn's disease activity by IHB and PCR showed a positive correlation with NAFLD. The high prevalence of NAFLD among CD patients should raise this concern for patient care.

Nonalcoholic Fatty Liver Disease in Patients with Type 2 Diabetes and Chronic Kidney Disease

Background: Nonalcoholic fatty liver disease (NAFLD) is suggested as a risk factor for chronic kidney disease (CKD). The incidence of NAFLD is rising globally in parallel to the increasing incidences of obesity and type 2 diabetes. Diabetes remains the leading cause of CKD, but the co-existence of NAFLD, CKD, and type 2 diabetes is not well elucidated. Here, we evaluated the prevalence of NAFLD in patients with type 2 diabetes with and without CKD. Methods: This was a cross-sectional study including 50 patients with type 2 diabetes and CKD stages 3–5 (no dialysis), and 50 patients with type 2 diabetes without CKD. Liver fat content was estimated by proton magnetic resonance spectroscopy and magnetic resonance imaging proton density fat fraction. NAFLD was defined as liver fat fraction ≥5.6% according to guidelines. Results: Mean age was 72 ± 4.9 years in patients with CKD and 65.9 ± 7.8 years in patients without CKD (p < 0.0001). Three out of four participants were men. BMI was 28.6 ± 3.5 kg/m² and 27 ± 4.0 kg/m² in patients with and without CKD, respectively (p = 0.0087). NAFLD was identified in 22 (44%) patients with CKD and 19 (38%) patients without CKD (p = 0.6845). Median (IQR) liver fat fraction was 4.7% (3.0–8.5) and 4.1% (2.9–7.7) in patients with and without CKD, respectively (difference in geometric means 5.3%, 95% CI −23; 45, p = 0.7463). Conclusion: These findings do not support any association between NAFLD and CKD (stages 3–5) in patients with type 2 diabetes.

Positive association between nonalcoholic fatty liver disease and growth hormone deficiency in patients with nonfunctioning pituitary adenoma.

Non-alcoholic fatty liver disease (NAFLD) is characterized by growth hormone deficiency (GHd). We investigated the association between NAFLD and GHd in patients with nonfunctioning pituitary adenomas (NFPA). We recruited patients with NFPA who underwent transsphenoidal adenectomy between January 2005 and December 2018. Pituitary function was determined by the insulin tolerance test, thyroid hormone assay, and gonadal hormone levels. NAFLD was defined as a hepatic steatosis index greater than 36. Among 278 patients (mean age, 44.2 years; 58.6% [n=163] female), 103 (37.0%) had GHd, 139 (50.0%) had hypogonadism, and 75 (27.0%) had NAFLD. The prevalence of NAFLD was significantly higher in patients with GHd than in those without (36.9% vs. 21.1%, p=0.01). Even after adjusting for age, total cholesterol level, gonadal function, and prolactin level, patients with GHd had approximately two-fold higher prevalence of NALFD than those without GHd (adjusted odds ratio [OR]=1.85, 95% confidence interval [CI]=1.05-3.28, p=0.03). Among female patients, the prevalence of NALFD was significantly higher in those with GHd than in those without (adjusted OR=2.39, 95% CI=1.03-5.55, p=0.04); whereas, among male patients, the prevalence of NAFLD was statistically similar between those with and without GHd (p>0.05). In addition, gonadal function did not affect the prevalence of NAFLD in patients with NFPA (29.3% with eugonadism vs. 47.8% with hypogonadism, p=0.14). Among patients with NFPA, the prevalence of NAFLD was two-fold higher in patients with GHd than that in those without GHd. Thus, screening for NAFLD might be required in NFPA patients with GHd.

Evaluation of nonalcoholic fatty liver disease in Japanese patients with psoriasis: Chest CT imaging for screening purposes.

Psoriasis patients have been reported to have a higher prevalence of nonalcoholic fatty liver disease (NAFLD), therefore detection at an early stage is important since it may progress to hepatic cirrhosis or hepatocellular carcinoma. We evaluated liver fat accumulation in patients with moderate to severe psoriasis by chest computed tomography (CT). The images were taken for screening purposes prior to the start of any biologics. The prevalence of NAFLD in patients with psoriasis vulgaris, psoriatic arthritis, and control subjects was 19.4%, 33.3% and 9.8%, respectively (P =0.004). The mean CT score in psoriasis patients was significantly lower (51.684 ± 12.778) than that in control subjects (61.204 ± 9.498, P < 0.001). Multivariate logistic regression analysis showed that only CT scores were associated with the presence of psoriasis (P =0.001). No significant relationship was observed between the Psoriasis Activity and Severity Index scores and CT scores of psoriasis patients (P =0.055), suggesting that the presence of psoriasis may contribute to the pathogenesis of NAFLD. By analysis of chest CT imaging, our study successfully assessed liver fat accumulation. Chest CT is a useful diagnostic tool for the quantitative measurement of fat accumulated in the liver, enabling the early noninvasive detection of NAFLD and early therapeutic intervention.

A clinical and laboratory-based nomogram for predicting nonalcoholic fatty liver disease in non-diabetic adults: a cross-sectional study.

Although the close relationship between nonalcoholic fatty liver disease (NAFLD) and insulin resistance has been clarified and there is a five-fold higher prevalence of NAFLD in patients with diabetes compared to that in patients without diabetes, this is not a reason to focus only on the incidence of NAFLD in people with diabetes because people who are insulin resistant are not necessarily diagnosed with diabetes, which leads to the overlook of NAFLD in non-diabetic population. Actually, we areobligated to pay more attention to the non-diabetic population for early detection and intervention of NAFLD. There is a lack of a convenient tool for predicting NAFLD in non-diabetic adults, and thus we aim to develop and validate a novel clinical nomogram to predict NAFLD among non-diabetic population to save more medical resources and make less missed diagnosis. Researchers initially enrolled 20,944 patients and excluded those with history of drinking, known medication usage, viral hepatitis, known liver disease, missing covariant data, age <18 years, and impaired fasting blood glucose, leaving 14,251 adults participating in the baseline analysis, who were randomly divided in a ratio of 3:1 into a training dataset with 10,689 participants and a validation dataset with 3,562 participants, using the classification and regression training (caret) package in R software v. 4.0.3. Variables for prediction were selected by multivariable logistic regression analysis, the LASSO method, and clinical experience. Based on these, we constructed a prediction model. Performance of this model was validated by the area under the receiver operator characteristic curve, calibration curve, and decision curve analysis. We used 6 variables to construct the prediction model: body mass index (BMI), aspartate aminotransferase (AST), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), hemoglobin A1c (HbA1c), and diastolic blood pressure (DBP). In the training and validation datasets, the AUROC value of this prediction was 0.891 [95% confidence interval (CI): 0.884 to 0.899] and 0.902 (95% CI: 0.890 to 0.914), respectively. The calibration plots and the decision curve analysis (DCA) demonstrated that the accuracy of this model was good, with high clinical practicability. The nomogram could screen non-diabetic adults for NAFLD and may aid clinical decision-making.

PII: S0035-3787(22)00484-2

The obesity epidemic has increased the risk of nonalcoholic fatty liver disease (NAFLD) in both the general and chronic hepatitis B (CHB) populations. Our study aims to determine the prevalence of NAFLD in patients with CHB based on controlled attenuation parameter (CAP) and the epidemiological, clinical, and virological factors associated with severe hepatic steatosis.The Canadian Hepatitis B Network cohort was utilized to provide a cross-sectional description of demographics, comorbidities, antiviral treatment, and hepatits B virus (HBV) tests. Liver fibrosis and steatosis were measured by transient elastography and CAP, respectively. Any grade and severe steatosis were defined as CAP >248 and >280 dB/m, respectively. Advanced liver fibrosis was defined as transient elastography measurement >10.7 kPa.In 1178 patients with CHB (median age: 47.4%, 57.7% males, 75.7% Asian, 13% African, 6.5% White, 86% HBV e antigen negative, median HBV DNA of 2.44 log10IU/mL, 42.7% receiving treatment), the prevalence of any grade and severe steatosis was 53% and 36%, respectively. In the multivariate analysis, obesity was a significant predictor for severe steatosis (adjusted odds ratio: 5.046, 95% confidence interval: 1.22–20.93). Severe steatosis was a determinant associated with viral load (adjusted odds ratio: 0.385, 95% confidence interval: 0.20–0.75, P < .01; r = −0.096, P = .007) regardless of antiviral therapy, age, and alanine aminotransferase levels.In this large multiethnic CHB population, hepatic steatosis is common. Severe steatosis is independently associated with higher fibrosis, but negatively with HBV DNA, regardless of antiviral therapy history.

Severe Hepatic Steatosis Is Associated With Low-Level Viremia and Advanced Fibrosis in Patients With Chronic Hepatitis B in North America.

The obesity epidemic has increased the risk of nonalcoholic fatty liver disease (NAFLD) in both the general and chronic hepatitis B (CHB) populations. Our study aims to determine the prevalence of NAFLD in patients with CHB based on controlled attenuation parameter (CAP) and the epidemiological, clinical, and virological factors associated with severe hepatic steatosis. The Canadian Hepatitis B Network cohort was utilized to provide a cross-sectional description of demographics, comorbidities, antiviral treatment, and hepatits B virus (HBV) tests. Liver fibrosis and steatosis were measured by transient elastography and CAP, respectively. Any grade and severe steatosis were defined as CAP >248 and>280 dB/m, respectively. Advanced liver fibrosis was defined as transient elastography measurement >10.7 kPa. In 1178 patients with CHB (median age: 47.4%, 57.7% males, 75.7% Asian, 13% African, 6.5% White, 86% HBV e antigen negative, median HBV DNA of 2.44 log10IU/mL, 42.7% receiving treatment), the prevalence of any grade and severe steatosis was 53% and 36%, respectively. In the multivariate analysis, obesity was a significant predictor for severe steatosis (adjusted odds ratio: 5.046, 95% confidence interval: 1.22-20.93). Severe steatosis was a determinant associated with viral load (adjusted odds ratio: 0.385, 95% confidence interval: 0.20-0.75, P<.01; r=-0.096, P=.007) regardless of antiviral therapy, age, and alanine aminotransferase levels. In this large multiethnic CHB population, hepatic steatosis is common. Severe steatosis is independently associated with higher fibrosis, but negatively with HBV DNA, regardless of antiviral therapy history.

Low awareness of non-alcoholic fatty liver disease in patients with type 2 diabetes in Swedish Primary Health Care

Objectives Non-alcoholic fatty liver disease (NAFLD) is more common in patients with type 2 diabetes mellitus (T2DM) compared to individuals without. Recent guidelines recommend screening for NAFLD in patients with T2DM. Our aim was to investigate the prevalence of NAFLD in patients with T2DM in a Swedish primary health care setting, how they are cared for and assess the risk of biochemical signs of advanced fibrosis. Material and methods In this cohort study, patients with T2DM from five primary health care centers were included. Medical records were retrospectively reviewed and living habits, medical history, results of diagnostic imaging and anthropometric and biochemical features were noted in a standardized form. The risk of steatosis and advanced fibrosis was assessed using commonly used algorithms (FLI, HSI, NAFLD-LFS, NAFLD ridge score, FIB-4 and NFS). Results In total 350 patients were included. Diagnostic imaging had been performed in 132 patients and of these, 34 (26%) had steatosis, which was not noted in the medical records in 16 (47%) patients. One patient with steatosis had been referred to a hepatologist. Of assessable patients, 71–97% had a high to intermediate risk of steatosis and 29–65% had an intermediate to high risk of advanced fibrosis according to the algorithms used. Conclusion This study indicates a high prevalence of NAFLD among T2DM patients in Swedish primary care. Patients with known NAFLD were followed up to a very low extent. Using fibrosis algorithms in primary health care would result in many patients needing further assessment in secondary care.

“Prevalence of NAFLD in Patients with Ischemic Heart Disease-A Study in Enam Medical College and Hospital in Bangladesh”

Background: Nonalcoholic fatty liver disease (NAFLD) has an in-creasing prevalence worldwide. It has also been closely associated with obesity and metabolic syndrome - two conditions known to be asso-ciated with ischemic heart disease (IHD). Several common metabolic risk factors contribute to development of both nonalcoholic fatty liver disease (NAFLD) and Ischemic Heart Disease worldwide with a preva-lence as high as 30% in the general population. Objective: To deter-mine prevalence of NAFLD in patients with Ischemic Heart Disease. Methods: The prospective study was conducted in the Department of Cardiology, Enam Medical College & Hospital, Savar, Bangladesh between January 2020 to December 2020. The study was conducted on 100 patients (62 patients with NAFLD and 38 Non-NAFLD) subjects were selected. Full history taking, clinical examination and laboratory tests including blood sugar, lipid profile and liver profile were done. Ultrasonography was performed to prove NAFLD while ECG and echocardiography were used for detection of myocardial ischemia. Results:The present study was by enrolling 100 patients of coronary artery disease divided into two groups i.e. NAFLD group n= 62 (62%) and Non NAFLD group n= 38 (38%). Participants were selected and divided into two groups; NAFLD group included 62 patients with ultrasonography NAFLD (45 males & 21 females) with mean age 45.81±12.46 years and non-NAFLD group of 38 subjects with mean age 45.32± 10.56 years. The present study shows that the prevalence of NAFLD was highest (86.8%) in more than 40 years of age group. The present study shows that the prevalence of NAFLD was more in males (84.2%) as compare to females (15.8%). The present study also shows significantly high incidence of metabolic syndrome in patients with NAFLD (23.7%) as compared to Non-NAFLD (3.2%) patients with Coronary Artery (CAD). Of the NAFLD group, the frequency of mild, moderate and severe NAFLD was 42.9%, 30% and 29.1% respectively. Subjects with NAFLD had a significantly higher BMI, waist circumference and weight compared to those of non NAFLD group (p=0.014, 0.0218 and <0.001 respectively). Independent risk factors for NAFLD were obesity, DM, high LDL, low HDL, waist circumference, glycated hemoglobin and IHD with odds ratios 1.09, 2.12, 1.01, 1.15, 1.13, 1.37 and 1.17 respectively. While independent risk factors for IHD included obesity, DM, high LDL, total cholesterol, triglycerides and the presence of NAFLD with odds ratios 1.31, 1.23, 1.19, 1.132, 1.68 respectively. Conclusion: The current study revealed that presence of NAFLD is associated with increased risk of IHD. This association was not only due to common risk factors shared between the two entities such as obesity, dyslipidemia and diabetes, but also a direct independent positive relationship was found between them. So NAFLD can be considered as an independent predictor of myocardial ischemia. The present study indicated a high prevalence of NAFLD in patients with documented Ischemic Heart Disease.

Prevalence and Predictors of Nonalcoholic Fatty Liver Disease in Family Members of Patients With Nonalcoholic Fatty Liver Disease

Nonalcoholic fatty liver disease (NAFLD) is the commonest cause of chronic liver disease worldwide. Despite the high prevalence, no screening recommendations yet exist. We designed a prospective observational study to estimate the prevalence of NAFLD in the family of patients with NAFLD and develop a predictive model for identifying it. The prevalence of NAFLD in patients' family members was estimated using ultrasonography, and univariate and multivariate odds were calculated for its predictors. A model was created using the significant parameters on multivariate odds, and its performance was tested using the area under the receiver operating characteristic (AUROC). Among447 family members of 191 patients with NAFLD, the prevalence of NAFLD was 55.9%. Family members with NAFLD were younger and had lower serum levels of aspartate aminotransferase, alanine aminotransferase (ALT), triglycerides. The liver stiffness measurement and controlled attenuation parameter values were also lesser in family members compared to the index cases. Age, body mass index (BMI), and ALT were independent predictors of NAFLD in the family members. A model combining age and BMI had an AUROC of 0.838 [95% confidence interval (CI) 0.800-0.876, P < 0.001]. Age ≥30 years and BMI ≥25kg/m2 had an odds ratio of 33.5 (95% CI 17.0-66.0, P < 0.001) for prediction of NAFLD, in comparison to BMI <25kg/m2 and age <30 years. Family members of patients with NAFLD are at increased risk of NAFLD. Screening strategies using BMI and age ensure early identification and could be beneficial in clinical practice.

Non-alcoholic fatty liver disease is associated with bacterial translocation and a higher inflammation response in psoriatic patients

Psoriasis and non-alcoholic fatty liver disease (NAFLD) are both inflammatory diseases. The study objective was to estimate the risk of NAFLD, non-alcoholic steatohepatitis, and liver fibrosis (by liver stiffness and liver biopsy) in patients with psoriasis and to determine the epidemiological, clinical, immunological (TNF-α, IL-2, IL-6, IL-12, IL-17, IL-23, and TGF-β) characteristics, and bacterial translocation. Of the 215 psoriatic patients included, 91 presented NAFLD (prevalence: 42.3%). Compared to patients with psoriasis alone, those with NAFLD were significantly more likely to have metabolic syndrome, diabetes, dyslipidemia, body mass index ≥ 30 kg/m2, homeostatic model assessment of insulin resistance ≥ 2.15, and greater psoriasis area severity index. NAFLD patients also had significantly higher levels of TNF-α (p = 0.002) and TGF-β (p = 0.007) and a higher prevalence of bacterial translocation (29.7% vs. 13.7%; p = 0.004). Liver stiffness measurement was over 7.8 kPa in 17.2% (15/87) of NAFLD patients; 13 of these underwent liver biopsy, and 5.7% (5/87) had liver fibrosis, while 1.1% (1/87) had advanced fibrosis or non-alcoholic steatohepatitis. In conclusion the prevalence of NAFLD in patients with psoriasis is high and associated with a higher prevalence of metabolic syndrome features, bacterial translocation and a higher pro-inflammatory state. It is worth mentioning that liver fibrosis and non-alcoholic steatohepatitis are not frequent in this population of patients.