Risk Factor For NAFLD Research Articles

Prevalence of nonalcoholic fatty liver disease and its correlated risk factors in health population in Guangzhou

Objective: To investigate the situation and its risk factors of nonalcoholic fatty liver (NAFLD) in health population, and to provide the scientific evidence for this disease control and prevention. Methods: The subjects who had health examination in our hospital from Jan 2014 to Jan 2015 were enrolled in this cross-sectional survey study. The medical history, body examination data (height, weight and blood pressure), biochemical data (blood lipid, blood sugar, liver function, etc.) and the ultrasound examination result were recorded. The descriptive analysis method was used to demonstrate the distribution of NALFD, and the single and multi-variable analysis method was conduct to obtain the risk factors of NAFLD. Result: The overall prevalence rate of NAFLD was 16.92%, while the rate of male group was greater than that of female group. Logistic regression showed that BMI, diastolic pressure, ALT, GGT, fasting blood-glucose, TG, HLD and LDL were the independent risk factors of NAFLD (P<0.05). HDL was negatively correlated with NAFLD and other factors were positively. Conclusions: The overall prevalence rate of NAFLD of health population was higher in Guangzhou. The factors correlated with metabolism syndrome were the risk factor of NAFLD.

Comments on "Rural Residency has a Protective Effect and Marriage is a Risk Factor for NAFLD".

Comments on "Rural Residency has a Protective Effect and Marriage is a Risk Factor for NAFLD".

PWE-036 The Use of Amino Terminal of Type III Pro-Collagen Peptide (P3NP) to Monitor Methotrexate Associated Liver Fibrosis

Introduction Methotrexate (MTX) is an important immunosuppressive drug commonly used to treat psoriasis and rheumatoid arthritis. Concern related to the potential of the drug to induce liver fibrosis has led to numerous guidelines on monitoring patients on methotrexate therapy. The amino terminal of type III pro-collagen peptide (P3NP) is an extension peptide that is cleaved and liberated into extracellular fluid and hence is a biomarker for collagen turnover. Increased levels occur during tissue repair and fibrosis, hence in principle P3NP has been used to monitor patients for potential adverse effect of hepatic fibrosis. Methods We reviewed all requests for P3NP received by clinical biochemistry service at Nottingham University Hospitals between 2010 and 2015. We assessed how the results of P3NP were acted upon, what further tests and investigations were performed on patients where raised P3NP were reported. A total of 7319 assays were analysed corresponding to 495 patients. The data were analysed to see what proportion of positive results went on to have a Fibroscan, liver biopsy and to see whether histological findings correlate with P3NP level. As well as basic demographic data, we looked at co-morbidities, imaging, transient elastography and other risk factors for liver disease. Results Of the 495 patient records examined 185 (37.3%) had a raised P3NP levels (>8 microg/L); of these, 33 (17.8%) were referred to hepatologists leading to 27/33 (69.7%) investigated with transient elastography and 8 (24.2%) having liver biopsy. Of those who had liver biopsy 6/8 (75%) showed NASH with early fibrosis and 25% showed advanced fibrosis from NAFLD; in addition to methotrexate therapy, all of these patients had one or more risk factors for NAFLD. A mean P3NP value of 11.4 correlated with NASH with any fibrosis and 16.4 microg/L correlated with advanced fibrosis. Conclusion Despite wide spread use of P3NP, raised P3NP are not investigated adequately. Although small number of patients undergoing liver biopsy had significant histological abnormality ranging from NASH to advanced fibrosis, all had additional risk factors for NAFLD indicating that MTX treatment could therefore be stratified according to co-morbid risk factors. Disclosure of Interest None Declared

TYPE 2 DIABETES

Objectives: To determine the prevalence and the associated risk factors ofNAFLD in Type 2 diabetic patients. Study Design: Cross sectional study. Setting: Diabeticclinic of Medical Unit 3, JPMC. Methods: It is a cross sectional study. 262 patients wereenrolled between the ages of 18-70 years attending Diabetes Clinic of Medical Unit III, JPMC.Each consenting patient underwent a detailed medical history-taking, physical examination,laboratory assessment and abdominal ultrasonography (US). Fatty liver was diagnosed onabdominal US on the basis of two out of the three criteria: increased hepatic echogenicity,blurring of liver vasculature and deep attenuation of the ultrasonographic signal. In accordancewith the guidelines, subjects diagnosed with NAFLD had to fulfill the following criteria: nohistory of current or past alcohol consumption, other systemic illness known to cause fatty liverdisease; absence of history and clinical, biochemical and US findings consistent with cirrhosis.Body mass index (BMI) was calculated. Blood pressures of greater than 130/90 were takenas hypertensive. LFTs, FBS, HbA1c, Lipid profiles were taken. Results: Out of 262 diabeticpatients 107 (40.8%) of them were found to be having NFALD. Prevalence was found out to behigher in age group of 41-50 years, females, obese &amp; in Pashtoon subjects.It was also moreprevalent in sedentary lifestyle patients and those on oral anti diabetics in contrast to insulintherapy. It was correlating well with US findings when the ALT cut-off value was taken as 30 IUfor males and 19 IU for females compared to standard values of ALT. There was associationwith hypertension, metabolic syndrome and dyslipidemia. Conclusion: Prevalence of NAFLDwas higher in our diabetic patients. Middle age, female gender and obesity were found to bestatistically strong risk factors in our study.

Risk Factors for NAFLD and Development of Advanced Fibrosis in Inflamatory Bowel Disease Patients

Risk Factors for NAFLD and Development of Advanced Fibrosis in Inflamatory Bowel Disease Patients

Country of birth modifies the association of fatty liver index with insulin action in Middle Eastern immigrants to Sweden

AimsNon-alcohol fatty liver disease (NAFLD) is a strong risk factor for insulin resistance and type 2 diabetes. The prevalence of NAFLD varies across populations of different ethnic backgrounds but the prevalence in Middle Eastern populations, which are at high risk of type 2 diabetes, is largely unknown. Using fatty liver index (FLI) as a proxy for NAFLD the aim was to calculate the odds of NAFLD (FLI≥70) given country of origin and further to investigate the associations between ISI and FLI. MethodsIn 2010–2012 we conducted a population-based study of individuals aged 30–75 years born in Iraq or Sweden, in whom anthropometrics, fasting blood samples and oral glucose tolerance tests were performed and sociodemography and lifestyle behaviors characterized. ResultsA higher proportion of Iraqis (N=1085) than Swedes (N=605) had a high probability of NAFLD (FLI≥70, 32.5 vs. 22.6%, p<0.001, age- and sex-adjusted data) and ISI was more severely impaired (70.7 vs. 95.9%, p<0.001). Independently of traditional risk factors for NAFLD, being born in Iraqi increased the risk of FLI≥70 (OR 1.59: 95% CI 1.15, 2.20). Furthermore, country of birth presented a stronger association between ISI and FLI≥70 in Iraqis than in Swedes (Pinteraction=0.019). ConclusionsOur data indicate that immigrants from Iraq are at higher risk of NAFLD. The finding that country of birth modifies the relationship of FLI with ISI, suggests that liver fat may be a stronger determinant of impaired insulin action and increased risk of type 2 diabetes in Iraqis than in Swedes.

NAFLD Appears to Be the Most Common Liver Disease in IBD Patients; IBD is Likely a Risk Factor for NAFLD

NAFLD Appears to Be the Most Common Liver Disease in IBD Patients; IBD is Likely a Risk Factor for NAFLD

The association between body mass index and non-alcoholic fatty liver disease

To investigate the association of body mass index (BMI) with alcoholic fatty liver disease (NAFLD). A cohort of 725 adult subjects underwent general health check-up at our hospital in July 2008, then were followed up in 2011. The clinical data including body mass index(BMI), blood pressure, lab testing results and liver ultrasonic findings were retrospectively analyzed. The NAFLD was diagnosed according to the guidelines for management of nonalcoholic fatty liver disease: an updated and revised edition in 2010 based on liver ultrasound results. The risk factors for NAFLD were analyzed with multivariate logistic regression. One hundred and sixty two NAFLD cases and 563 non-NAFLD cases were found in 2008 check-up. Among 563 non-NAFLD subjects, NAFLD was developed in 132 (23.4%) at follow-up in 2011. The incidence of NAFLD was correlated with the baseline BMI (χ²=82.861，P<0.01). Multivariate logistic regression analysis showed that baseline BMI，systolic blood pressure, alanine aminotransferase and the increase of BMI were the independent risk factors, while high density lipoprotein-cholesterol (HDL-C) was the protective factor for the development of NAFLD. Among 162 NAFLD cases, 71 (43.8%) had no evidence of NAFLD at the second check-up in 2011. The remission of NAFLD was negatively correlated with baseline BMI (χ²=22.425，P<0.01). Multivariate logistic regression analysis showed that male sex, baseline BMI and the increase of BMI were negatively associated with remission of NAFLD, while the age was positively associated with the remission of NAFLD. The development and remission of NAFLD are frequently encountered in health check-up subjects, which are closely related to baseline BMI and changes of BMI during the follow-up．

Characterization and prognosis of patients with hepatocellular carcinoma (HCC) in the non-cirrhotic liver

BackgroundHCC predominantly develops in the condition of chronic inflammation that has led to liver cirrhosis. A small proportion of patients with HCC is diagnosed in the non-cirrhotic liver (NCL). Data on patients with HCC in NCL in advanced stages are scarce.MethodsA retrospective analysis was performed comparing 93 patients with HCC in NCL to 571 patients with HCC in liver cirrhosis (LC) with respect to clinical and demographic characteristics. Also factors influencing survival in patients with HCC in NCL were analyzed.ResultsPatients with HCC in NCL were diagnosed at older age and in more advanced tumor stages than patients with LC. More than 25% of patients with HCC in NCL presented with extrahepatic metastases. Only a minority of patients with HCC in NCL lacked any sign of hepatic damage. Risk factors for LC and risk factors for NAFLD are present in the majority of patients with HCC in NCL. The BCLC classification corresponded with the survival of patients with HCC in NCL although the therapeutic options differ from those for patients with liver cirrhosis.ConclusionsIt will be one of the major challenges in the future to awake awareness of carrying a risk of hepatic malignancies in patients with chronic liver diseases apart from liver cirrhosis, especially in NAFLD. Surveillance programs need to be implemented if these are cost-effective.

Weight trajectories through infancy and childhood and risk of non-alcoholic fatty liver disease in adolescence: The ALSPAC study

Background & AimsAdiposity is a key risk factor for NAFLD. Few studies have examined prospective associations of infant and childhood adiposity with subsequent NAFLD risk. We examined associations of weight-for-height trajectories from birth to age 10 with liver outcomes in adolescence, and assessed the extent to which associations are mediated through fat mass at the time of outcome assessment.MethodsIndividual trajectories of weight and height were estimated for participants in the Avon Longitudinal Study of Parents and Children using random-effects linear-spline models. Associations of birthweight (adjusted for birth length) and weight change (adjusted for length/height change) from 0–3 months, 3 months–1 y, 1–3 y, 3–7 y, and 7–10 y with ultrasound scan (USS) determined liver fat and stiffness, and serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma-glutamyl transferase (GGT) at mean age 17.8 y were assessed with linear and logistic regressions. Mediation by concurrent fat mass was assessed with adjustment for fat mass at mean age 17.8 y.ResultsBirth weight was positively associated with liver stiffness and negatively with ALT and AST. Weight change from birth to 1 y was not associated with outcomes. Weight change from 1–3 y, 3–7 y, and 7–10 y was consistently positively associated with USS and blood-based liver outcomes. Adjusting for fat mass at mean age 17.8 y attenuated associations toward the null, suggesting associations are largely mediated by concurrent body fatness.ConclusionsGreater rates of weight-for-height change between 1 y and 10 y are consistently associated with adverse liver outcomes in adolescence. These associations are largely mediated through concurrent fatness.

Iron in Child Obesity. Relationships with Inflammation and Metabolic Risk Factors

Iron (Fe) sequestration is described in overweight and in its associated metabolic complications, i.e., metabolic syndrome (MetS) and non-alcoholic liver fatty disease (NAFLD); however, the interactions between Fe, obesity and inflammation make it difficult to recognize the specific role of each of them in the risk of obesity-induced metabolic diseases. Even the usual surrogate marker of Fe stores, ferritin, is influenced by inflammation; therefore, in obese subjects inflammation parameters must be measured together with those of Fe metabolism. This cross-sectional study in obese youth (502 patients; 57% girls): 11.4 ± 3.0 years old (x ± SD); BMI z score 5.5 ± 2.3), multivariate regression analysis showed associations between Fe storage assessed by serum ferritin with risk factors for MetS and NAFLD, assessed by transaminase levels, which were independent of overweight and the acute phase protein fibrinogen. Further studies incorporating the measurement of complementary parameters of Fe metabolism could improve the comprehension of mechanisms involved.

Editorial : Cholecystectomy and NAFLD: Does Gallbladder Removal Have Metabolic Consequences?

Pathogenesis of nonalcoholic fatty liver (NAFLD) disease and gallbladder (GB) disease secondary to cholesterol gallstones is complex, yet both conditions share similar associated risk factors, most of them related to the metabolic syndrome. Cholecystectomy, the best treatment for GB disease, is one of the most performed abdominal surgeries worldwide. In this issue of the American Journal of Gastroenterology, Ruhl and Everhart, using data from the Third United States National Health and Nutrition Examination Survey (1988-1994), show that NAFLD is associated with cholecystectomy (odds ratio (OR)=2.4; 1.8-3.3), but not with gallstones (OR=1.1; 0.84-1.4). This finding suggests that cholecystectomy may itself represent a risk factor for NAFLD, which is in line with the recently undisclosed role of the GB and bile acids in systemic metabolic regulation. Thus, cholecystectomy may not be innocuous and may have a major impact on public health by contributing to NAFLD development.

A study of simple anthropometric indices like waist circumference and waist height ratio as predictors of NAFLD in coastal eastern India

Background and Aims: NAFLD encompasses a spectrum of liver disorders ranging from simple steatosis through steatohepatitis to cirrhosis.Although obesity is a known risk factor for NAFLD, many recent studies have indicated that visceral fat accumulation may be a more important risk factor for metabolic syndrome and NAFLD than overall obesity.Waist circumference is a well-known surrogate marker of abdominal fat accumulation, may underestimate the relative amount of abdominal fat in short subjects and even may overestimate it in tall subjects.

Prevalence and factors associated with nonalcoholic fatty liver disease in shanghai work-units

BackgroundsNonalcoholic fatty liver disease (NAFLD) has become the most common chronic liver disease in Asians. However, data on prevalence and factors associated with NAFLD in Asians are lacking. The aim of this study is to investigate the prevalence of NAFLD in Shanghai employees to assess the relationship between NAFLD and age, gender, metabolic risk factors in this studied population.MethodsWe selected 7152 employees of Shanghai work-units. Each of them underwent detailed medical history-taking, physical examination, laboratory assessments and abdominal ultrasonography. The diagnosis of NAFLD was done according to established criteria. Receiver operating characteristics (ROC) curves were applied to detect areas under the ROC curves for each index. Nominal logistic regression analysis was used to estimate the odds ratio for risk factors of NAFLD.ResultsAbout 38.17% employees had NAFLD, more in men than in women. The prevalence of NAFLD increased with increasing age. In both genders, the prevalence of metabolic factors was higher in the NAFLD group. Body max index, waist circumference, weight-to-height ratio, blood pressure, blood glucose, total cholesterol, triglyceride, low density lipoprotein, high density lipoprotein and uric acid were found to have a diagnostic value for NAFLD. Body max index is a better index for diagnosing NAFLD. Uric acid is a new diagnosing index not inferior to lipid metabolic factors. Metabolic factors can increase the risk of NAFLD up to 1.5 ~ 3.8 times.ConclusionsOlder age, male gender, metabolic factors such as obesity, abdominal obesity, dyslipidemia, hypertension or type 2 diabetes are risk factors for NAFLD. Prevalence of NAFLD in Shanghai employees is high. Prevention is extremely important. Those achieve the critical point should have early intervention.

Tu1032 Relationship Between the Plasma Concentrations of Free Choline and Parameters of Adiposity and Histological Findings in Patients With Nonalcoholic Fatty Liver Disease. a Multicenter Study in Japan

A S L D A b st ra ct s who met at least 1 of the following exclusion criteria (consuming ≥20 g/day of alcohol, testing positive for HBs-Ag or, demonstrating evidence of liver disease other than viral hepatitis, and/or currently taking anti-hypertensive agents, lipid-lowing agents, or antidiabetic agents), the records of 6,370 Japanese subjects were reviewed for identification of subjects meeting the diagnostic criteria for NAFLD (evidence of hepato-renal contrast and liver brightness on abdominal ultrasound) and the variables associated with NAFLD in order to estimate ideal ALT cutoff levels. Results: The results of multivariate analysis of the 1,346 subjects (803 males and 543 females) who met the diagnostic criteria for NAFLD confirmed that the traditional markers of metabolic disease are also markers of NAFLD: high BMI, ALT, TG, HDL-c, UA, and HbA1c levels. Of the significant risk factors for NAFLD, ALT level, one themost common variables in screening for liver disease, was selected for estimation of its cutoff level in diagnosing NAFLD. The area under receiver operating characteristic curve (AUC), cutoff level, sensitivity, specificity, PPV, NPV, and diagnostic accuracy in predicting NAFLD in males were found to be 0.807, 25 IU/l, 75.2%, 71.0%, 63.2%, 81.7%, and 73.1%, respectively, whereas those for females were found to be 0.747, 17 IU/l, 65.8%, 70.5%, 24.2%, 93.5%, and 69.9%, respectively. The sensitivity, specificity, PPV, and diagnostic accuracy results indicate that using a cut-off level of 25 U/L for males and 17 U/L for females allows for diagnosis of NAFLD with a high degree of specificity and accuracy, while the results for NPV indicate the utility of using these levels as tools in the identification of healthy subjects for further research. Conclusions: ALT level was confirmed to be a surrogate marker for NAFLD in addition to markers associated with metabolic diseases. The ALT cutoff level used in NAFLD diagnosis should be revised downward to identify subjects at risk of NAFLD to prevent NAFLD progression and the development of associated diseases.

Prevalence and Risk Factors of NAFLD among Native South Asian Pakistani Patients with Type 2 Diabetes and Metabolic Syndrome

Prevalence and Risk Factors of NAFLD among Native South Asian Pakistani Patients with Type 2 Diabetes and Metabolic Syndrome

The Risk Factors of NAFLD in Population of Russian Federation. Results of Open Multicenter Prospective Study Direg_l_01903

The Risk Factors of NAFLD in Population of Russian Federation. Results of Open Multicenter Prospective Study Direg_l_01903

Liver function tests as indicators of metabolic syndrome

Liver function tests as indicators of metabolic syndrome

Epidemiological survey on NAFLD and its risk factors in enterprises employees of Rizhao region

Objective To investigate the prevalence and its major risk factors of NAFLD among enterprises employees of Rizhao region. Methods 8 259 employees aged over 18 were selected by multi-stage stratified random cluster sampling method in the enterprises of Rizhao region. The data were analyzed, such as height, weight, blood pressure,blood lipids,blood sugar,hepatitis series,and ECG,abdominal ultrasound,chest χ ray were conducted in the fasting state. The diagnosis of NAFLD was in line with diagnostic criteria adopted by China Institute of Liver Disease and alcoholic liver disease group, and the prevalence and major risk factors of NAFLD were investigated. Results The prevalence of NAFLD was 18. 1% (male 23.0% ,female 7. 6%;the ratio of male to female:3. 03:1) ,The prevalence of NAFLD reached a peak from 40 to 50 in male and after the age of 70 in female,and there was no statistically difference after the age of 50 between male and female. The close correlation was demonstrated by Logistic regression analysis between sex, hyperuricemia, HDLC, overweight or obesity, hyperglycemia, hypertriglyceridemia and NAFLD. Conclusion The prevalence of NAFLD was high, especially in older persons in enterprises employees of Rizhao region, and sex,hyperuricemia,HDLC,overweight or obesity,hyperglycemia and hypertriglyceridemia were closely associated with NAFLD. Key words: Fatty liver; Risk factors; Epidemiological survey

Predictors of pathological severity in non‐alcoholic fatty liver disease: Is East meeting West in the middle?

1In the general population, the current best estimate of the prevalence of NAFLD and NASH shows figures of 20% and 2‐3%, respectively. 2 However, great disparity exists among various estimates and this can be attributed to both patient selection and the methods used to assess prevalence of the disease. Despite objective flaws in the estimates of the disease, it is believed that NAFLD likely represents the most common liver disease in the Western world. NAFLD is considered a disorder of affluence due to its close association with obesity and metabolic disorders which, in turn, can be considered proxies for a sedentary lifestyle and unhealthy nutritional habits. Until recently, it was believed that the prevalence of NAFLD should have been lower in countries that had not been affected by globalization, and where physical inactivity and over-nutrition are uncommon. On the contrary, more recent studies from nonurbanized regions of India, China and Indonesia have clearly documented a significant prevalence of fatty liver in the general population. More importantly, they confirmed an association between NAFLD and metabolic disorders even in these not yet urbanized Eastern regions of the world. 3‐5 These studies have led to a greater awareness of the ‘epidemic’ of NAFLD in the AsiaPacific region, as well as of the specific risk factors and picture of disease in patients from this part of the world. 6,7 In a recent, large survey carried out on the Korean general population, the prevalence of the metabolic syndrome was 29.3% and 22.3% in the rural and urban community, respectively. 8 Although no precise estimates have been made regarding the prevalence of NAFLD in Korea, the prevalence of patients with cryptogenic hepatocellular carcinoma has significantly increased over the last decade, and these patients showed a parallel trend towards increased risk factors for NAFLD. 9 Therefore, it is not surprising that the presence of NASH is associated with an increasing body mass index (BMI) in this country too. In fact, in a series of 43 non-cirrhotic NAFLD Korean patients, BMI and the presence of obesity were the only predictors of NASH and BMI alone was associated with the presence of fibrosis in NASH patients.