scholarly journals Determinants of Hepatocellular Carcinoma in the United States: Differences in Risk Factor and Genetic Susceptibility by Race/Ethnicity

2021 ◽  
pp. 18-33
Author(s):  
Mehwish Rafique ◽  
Dana Kristjansson
Keyword(s):  
Risk Factors ◽  
Hepatocellular Carcinoma ◽  
Liver Disease ◽  
Genetic Analysis ◽  
Genetic Susceptibility ◽  
The United States ◽  
Metabolic Risk Factors ◽  
Metabolic Risk ◽  
Alcoholic Fatty Liver ◽  
Race Ethnicity

Background: Hepatocellular carcinoma (HCC) is one of the few cancers with an increasing incidence and mortality worldwide. This study aims to determine the contribution of known risk factors for HCC by race and ethnicity. Methods: Data on race, ethnicity, age, and gender were obtained from National Health and Nutrition Examination Survey (NHANES). Population attributable fractions (PAFs) of risk factors were estimated using non-invasive scoring measures of Hepatitis B and C virus infection, excessive alcohol use, smoking, diabetes and emerging metabolic risk factors [non-alcoholic steatohepatitis advanced cirrhosis (NASH) and non-alcoholic fatty liver disease-advanced fibrosis (NAFLD-fib)] over a 10-year period, 1999-2002 and 2009-2012. Genetic analysis was performed using DisGenet platform by attaining the top enriched genes strongly related to HCC. Furthermore, cytoscape network was used to form a gene-disease network association. Results: NASH-cirrhosis increased in the overall population and among all race and ethnic groups. Both liver fat accumulation and ALT levels vary among different populations; however, Hispanics have the highest prevalence of NAFLD and elevated ALT levels. Non-Hispanic (NH) blacks and Hispanics had a 3 to 4 times higher PAF for HCC than whites attributed due to chronic liver diseases, including NASH-cirrhosis and NAFLD-fib. Our genetic analysis demonstrated that PNPLA3 polymorphism is strongly associated with NAFLD-fib, which appears to represent susceptibility to liver disease among the Hispanic community. Conclusion: Hispanics and NH blacks are at a disproportionately higher risk for HCC in part due to the higher prevalence of liver disease comorbidities, including NASH-cirrhosis and NAFLD-fib. Compared to NH whites, Hispanics and NH blacks have a higher baseline risk for liver cancer due to non-metabolic factors, which may include a genetic susceptibility. Metabolic risk factors have increased and are now contributing to nearly half of HCC cases in the US.

scholarly journals Implementation of a care bundle improves the management of patients with non-alcoholic fatty liver disease

2021 ◽  
pp. flgastro-2020-101480
Author(s):  
Laura Jane Neilson ◽  
Louise Macdougall ◽  
Phey Shen Lee ◽  
Timothy Hardy ◽  
David Beaton ◽  
...  
Keyword(s):  
Risk Factors ◽  
Liver Disease ◽  
Fatty Liver ◽  
Fatty Liver Disease ◽  
Metabolic Risk Factors ◽  
Care Bundle ◽  
Metabolic Risk ◽  
Lifestyle Advice ◽  
Alcoholic Fatty Liver ◽  
Alcoholic Fatty Liver Disease

BackgroundNon-alcoholic fatty liver disease (NAFLD) is common and is associated with liver-related and cardiovascular-related morbidity. Our aims were: (1) to review the current management of patients with NAFLD attending hospital clinics in North East England (NEE) and assess the variability in care; (2) develop a NAFLD ‘care bundle’ to standardise care; (3) to assess the impact of implementation of the NAFLD care bundle.MethodsA retrospective review was conducted to determine baseline management of patients with NAFLD attending seven hospitals in NEE. A care bundle for the management of NAFLD was developed including important recommendations from international guidelines. Impact of implementation of the bundle was evaluated prospectively in a single centre.ResultsBaseline management was assessed in 147 patients attending gastroenterology, hepatology and a specialist NAFLD clinic. Overall, there was significant variability in the lifestyle advice given and management of metabolic risk factors, with patients attending an NAFLD clinic significantly more likely to achieve >10% body weight loss and have metabolic risk factors addressed. Following introduction of the NAFLD bundle 50 patients were evaluated. Use of the bundle was associated with significantly better documentation and implementation of most aspects of patient management including management of metabolic risk factors, documented lifestyle advice and provision of NAFLD-specific patient advice booklets.ConclusionThe introduction of an outpatient ‘care bundle’ led to significant improvements in the assessment and management of patients with NAFLD in the NEE and could help improve and standardise care if used more widely.

Abstract P395: Non-Alcoholic Fatty Liver Disease in a Lean Population is Associated with Hypertension Independent of Metabolic Risk Factors

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Adil Karim ◽  
Pragya Sinha ◽  
Ehimen Aneni ◽  
Ebenezer T Oni ◽  
Michael J Blaha ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Liver Disease ◽  
Fatty Liver ◽  
Fatty Liver Disease ◽  
Density Lipoprotein ◽  
Metabolic Risk Factors ◽  
Metabolic Risk ◽  
Alcoholic Fatty Liver ◽  
Nonalcoholic Fatty Liver

Introduction: Hypertension is the most common causal risk factor for coronary artery disease. The increased prevalence of hypertension in those with nonalcoholic fatty liver disease (NAFLD) is well studied. Less well studied is the prevalence of hypertension in lean (BMI<25) individuals with NAFLD. This warrants attention since the burden of cardiovascular disease is increasingly shifting to the lean. Methods: The data for this study was obtained from a cohort of 6464 Brazilians (41.4+/-9 Y, 62% M) free of diabetes mellitus or cardiovascular disease. Of these, 39% (n=2508) were lean (BMI<25). Hypertension was defined as systolic BP (SBP) ≥ 140 mmHg or DBP ≥90 mmHg, self-identification as hypertensive or being on medication for hypertension. NAFLD was diagnosed using ultrasound in those with <20g/d alcohol intake. Results: The prevalence of hypertension in the lean population was nine percent. NAFLD was significantly associated with the presence of hypertension. The prevalence of hypertension was 16% and 8% in those with and without NAFLD respectively (p<0.001). In a multivariate analysis controlling for age, gender, triglyceride and high density lipoprotein cholesterol, the risk of hypertension in those with NAFLD was 1.54 times those without NAFLD(p<0.001). Conclusion: There is significantly increased prevalence of hypertension in lean, healthy individuals with NAFLD. This association is present even after adjusting for age, gender and metabolic risk factors. This relationship needs to be explored further since an increasing number of lean individuals have NAFLD on examination (Younossi et al., 2012).

scholarly journals Evidence based literature review of clinical management of non-alcoholic fatty liver disease in real world settings

2017 ◽  
Vol 6 (5) ◽  
pp. 1020
Author(s):  
Gourdas Choudhuri ◽  
Varun Gupta
Keyword(s):  
Risk Factors ◽  
Liver Disease ◽  
Fatty Liver ◽  
Lifestyle Intervention ◽  
Real World ◽  
Fatty Liver Disease ◽  
Metabolic Risk Factors ◽  
Metabolic Risk ◽  
Alcoholic Fatty Liver ◽  
Alcoholic Fatty Liver Disease

The aim of the present review is to understand the gap between real world clinical practices, guidelines recommendations and to propose minimum essentials that can be followed in clinical practice in NAFLD patients in India. A detailed literature search of published medical reports in English language was performed on electronic databases such as PubMed and Cochrane, from 2000 to 2016 using relevant search terms. The search yielded 25 relevant articles whose full texts were retrieved and evaluated. Non-alcoholic fatty liver disease (NAFLD) is an emerging cause of liver disease in India. It is observed that physicians under appreciate the overlap between NAFLD and metabolic risk factors, thus missing a significant proportion of high-risk NAFLD patients. Lifestyle intervention is generally considered the first line therapy for patients with NAFLD without steatohepatitis while pharmacotherapy (in addition to lifestyle intervention) is suggested for patients with non-alcoholic steatohepatitis (NASH). Current therapies are directed towards improving the metabolic parameters which contribute to disease pathogenesis. Pharmacological therapies for NAFLD and NASH include antioxidants such as vitamin E and ursodeoxycholic acid; insulin sensitizers such as metformin and thiazolidinones, weight loss drugs like orlistat and consideration of bariatric surgery for morbidly obese patients. High degree of suspicion is necessary for diagnosing NAFLD in patients with metabolic risk factors. Further studies are required from India as genotype/clinico-pathological profile of Indian NAFLD patients differ from the western population. Further, prospective studies will fill the various missing links associated with management of NAFLD in Indian patients in a more effective manner.

scholarly journals Comparative analysis of metabolic risk factors for progression of non-alcoholic fatty liver disease

2021 ◽  
Vol 7 (2) ◽  
pp. 241-247
Author(s):  
Vincent J. H. Yao ◽  
Michael Sun ◽  
Aivi A. Rahman ◽  
Zachariah Samuel ◽  
Joyce Chan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Liver Disease ◽  
Comparative Analysis ◽  
Fatty Liver ◽  
Fatty Liver Disease ◽  
Metabolic Risk Factors ◽  
Metabolic Risk ◽  
Alcoholic Fatty Liver ◽  
Alcoholic Fatty Liver Disease
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