1,720,960 research outputs found
FIRST RESULTS OF THE EVOLUTION AND THE INFLUENCE OF STATIN TREATMENT ON NAFLD IN A PRIMARY CARE COHORT OVER A 2-YEAR PERIOD
No full textBackground: A novel term, metabolic dysfunction-associated fatty liver disease (MAFLD), was proposed by a group of experts. However, it remains unclear whether hepatic steatosis per se in MAFLD contributes to an elevated risk of mortality in individual's with overweight/obesity, metabolic dysregulation, or type 2 diabetes mellitus (DM) (referred to as the metabolic dysfunction-association (MA) group), which are known significant risk factors for increased mortality. This study aimed to compare all-cause and cause-specific mortality between the 'MAFLD' group and the 'MA without fatty liver' group. Methods: A total of 10,052 participants from NHANES III were included. Fatty liver was diagnosed using ultrasound, and MAFLD was defined based on the criteria proposed by an international panel of experts. Mortality risks were compared between the 'MAFLD' group and the 'MA without fatty liver' group using the Cox proportional hazards model with complex survey design weights, adjusted for demographic and anthropometry factors (age, sex, race, body mass index and waist circumference), social history (education, marriage status, smoking and alcohol history and exercise) and comorbidity variables (hypertension, DM and hyperlipidemia). Linked mortality data, including all-cause, cancer, cardiovascular, and other causes-related mortality, were examined from 1988 through 2019. For liver-related mortality, data were evaluated from 1988 through 2006. Results: Over an average follow-up period of 23.0 years, the 'MAFLD' group did not exhibit a significant increase in all-cause mortality (adjusted hazard ratio [95% confidence interval], 1.07 [0.99-1.16], P = 0.100), cancer mortality (1.08 [0.86-1.36], P = 0.508), or cardiovascular mortality (0.89 [0.78-1.02], P = 0.084) compared to the 'MA without fatty liver' group. However, other causes-related mortality , which included liver-related mortality, was higher in the MAFLD group (1.36 [1.14-1.62], P = 0.001). This trend persisted in sensitivity analyses conducted on participants without viral hepatitis or heavy alcohol consumption. No significant effect modification was observed according to subgroups. Liver-related mortality , assessed over a 13.8-year follow-up period, showed a marginal increase in the 'MAFLD' group (2.49 [0.99-6.23], P = 0.052) compared to the 'MA without fatty liver' group. Conclusion: The 'MAFLD' group did not demonstrate an elevated risk of all-cause, cardiovas-cular, or cancer mortality when compared to the 'MA without fatty liver' group. However, there was a trend toward an increased risk of liver-related mortality in the MAFLD group
FIRST RESULTS OF THE EVOLUTION AND THE INFLUENCE OF STATIN TREATMENT ON NAFLD IN A PRIMARY CARE COHORT OVER A 2-YEAR PERIOD
No full textBackground: A novel term, metabolic dysfunction-associated fatty liver disease (MAFLD), was proposed by a group of experts. However, it remains unclear whether hepatic steatosis per se in MAFLD contributes to an elevated risk of mortality in individual's with overweight/obesity, metabolic dysregulation, or type 2 diabetes mellitus (DM) (referred to as the metabolic dysfunction-association (MA) group), which are known significant risk factors for increased mortality. This study aimed to compare all-cause and cause-specific mortality between the 'MAFLD' group and the 'MA without fatty liver' group. Methods: A total of 10,052 participants from NHANES III were included. Fatty liver was diagnosed using ultrasound, and MAFLD was defined based on the criteria proposed by an international panel of experts. Mortality risks were compared between the 'MAFLD' group and the 'MA without fatty liver' group using the Cox proportional hazards model with complex survey design weights, adjusted for demographic and anthropometry factors (age, sex, race, body mass index and waist circumference), social history (education, marriage status, smoking and alcohol history and exercise) and comorbidity variables (hypertension, DM and hyperlipidemia). Linked mortality data, including all-cause, cancer, cardiovascular, and other causes-related mortality, were examined from 1988 through 2019. For liver-related mortality, data were evaluated from 1988 through 2006. Results: Over an average follow-up period of 23.0 years, the 'MAFLD' group did not exhibit a significant increase in all-cause mortality (adjusted hazard ratio [95% confidence interval], 1.07 [0.99-1.16], P = 0.100), cancer mortality (1.08 [0.86-1.36], P = 0.508), or cardiovascular mortality (0.89 [0.78-1.02], P = 0.084) compared to the 'MA without fatty liver' group. However, other causes-related mortality , which included liver-related mortality, was higher in the MAFLD group (1.36 [1.14-1.62], P = 0.001). This trend persisted in sensitivity analyses conducted on participants without viral hepatitis or heavy alcohol consumption. No significant effect modification was observed according to subgroups. Liver-related mortality , assessed over a 13.8-year follow-up period, showed a marginal increase in the 'MAFLD' group (2.49 [0.99-6.23], P = 0.052) compared to the 'MA without fatty liver' group. Conclusion: The 'MAFLD' group did not demonstrate an elevated risk of all-cause, cardiovas-cular, or cancer mortality when compared to the 'MA without fatty liver' group. However, there was a trend toward an increased risk of liver-related mortality in the MAFLD group
The effect of standard of care lifestyle advice by a hepatologist in a routine clinical practice on steatosis and fibrosis development among NAFLD patients
No full textBackground and aims: Weight loss through lifestyle modifications remains the mainstay for NAFLD treatment; however, implementing effective lifestyle interventions in clinical practice has been challenging due to time and cost constraints. Having a comprehensive approach to weight loss in patients with NAFLD that can be scaled and provided at low cost is a key unmet need. The objective of this study is to assess the effects of a mobile weight management program on weight loss and liver health biomarkers in adults with obesity and NAFLD. Method: Adults with obesity (BMI 30 to 49.9 kg/m 2 inclusive) and evidence of NAFLD based on Fibroscan CAP ≥274 dB/m were included. Patients were given access to the Noom Weight program for 16 weeks (midpoint) and then were followed for an additional 8 weeks (week 24 or end point). Measurements completed at baseline, midpoint, and end point included: weight/BMI, Fibroscan, routine labs (Complete Metabolic Panel and CBC), and the exploratory biomarker cytokeratin 18 fragment (CK18f). All tests of significance were performed at alpha = 0.05, two sided. Results: 40 subjects were enrolled and 82.5% (33/40) completed the study. The mean age was 55.9 years (range 29-79) with a mean BMI of 38 kg/m2 (30.5-49.8) and a mean baseline CAP score of 331.9 db/m 2 (276-396) and a mean LSM of 7.54 kPa (4.9-13.3). The average change in body weight from baseline was a 4.0% reduction and 32.4% (11/34) achieved total body weight reduction by 5% or more. There was a significant reduction in the CAP score by end point of 21.35 dB/ m (p = 0.024). The ALT decreased by 10 U/L or more in 27.3% (9/33). There was moderate correlation between BMI decrease and reduction in the CAP score (R = 0.533). There was no change in the LSM at the end point, and 62% (21) of subjects achieved >5% drop in CK18f. The change in CK18f correlated weakly (R = 0.215) with BMI drop but more strongly with Fibroscan CAP score (R = 0.468) and LSM (R = 0.764). Conclusion: The Noom Weight program had beneficial effects in patients with obesity and NAFLD, including significant reduction in the CAP score and one third of patients achieving 5% or more reduction in their weight. Steatosis of the liver was affected by weight loss as a result of engagement with the Noom Weight program. Fibrosis was not significantly affected by the Noom Weight program in the timeframe of the study. Fibrosis may require a longer timeframe for changes to be measured. FRI-526 The effect of standard of care lifestyle advice by a hepatologist in a routine clinical practice on steatosis and fibrosis development among NAFLD patients Background and aims: Non-alcoholic fatty liver disease (NAFLD) has become the most frequent cause of chronic liver disease. The leading cause of NAFLD has been defined as a behavioural phenotype comprising low physical activity and an obesogenic diet. The primary therapeutic advice is lifestyle changes leading to weight loss. Previous studies indicated that a weight reduction of 5% or more could induce regression of steatosis or fibrosis. However, hepatolo-gists only have time during consultations to give a short outline of the optimal lifestyle. As no data is available on the outcome of this routine practice, we evaluated the effect of this lifestyle advice on steatosis and fibrosis development among NAFLD patients. Figure: (abstract: FRI-524) The median change in clinic-laboratory parameters POSTER PRESENTATIONS S828 Journal of Hepatology 2023 vol. 78(S1) | S100-S1212 Method: Data were collected retrospectively using the electronic patient files of NAFLD patients in whom a baseline and a follow-up FibroScan® measurement (for assessment of steatosis by CAP™ and of liver stiffness (LSM) as a surrogate for fibrosis) were performed between November 2019 and 2022 at Ziekenhuis Oost-Limburg, Genk, Belgium. At the start, patients received Mediterranean diet related-advice, tips on improving exercise, and an information brochure concerning NAFLD from the hepatologist. Clinically meaningful weight loss was defined as a loss of at least 1 kg. Results: Of the 218 NAFLD patients evaluated, 130 (59.6%) were excluded due to the usage of semaglutide, not fasting, IQR/MED>30%, or bariatric surgery. In total, 88 (40.4%) patients were included, of whom 53 (60.2%) were men and 38 (43.2%) had type 2 diabetes mellitus (T2DM). The mean age, median BMI, and mean waist circumference were 54 ± 13 years, 31.0 (28.4-34.9) kg/m² and 105.2 ± 12.7 cm, respectively. On average, there were 186 (124-280) days between the measurements. The median weight loss between measurements was −1.2 (−4.1;1.4) kg. The decrease in LSM and CAP™ were −1.2 (−3.1;0.3) kPa and −7.0 (−50.5;8.8) dB/m, respectively. Within this group, 47 (53.4%) had clinically meaningful weight loss, while 41 (46.6%) did not lose any weight or gained weight. The group with weight loss developed a significantly (p 50 years), or having T2DM or not (p > 0.05). Conclusion: To the best of our knowledge, this is the first study to assess the effect of routine lifestyle advice by a hepatologist on body weight, steatosis, and fibrosis, measured by FibroScan®. The lifestyle advice leads to a weight reduction of at least −1 kg in almost half of NAFLD patients and a significant reduction in steatosis over six months in those patients. However, the recommended reduction in body weight (at least 5%) is not reached. Other measures to support the advice on lifestyle change given by the hepatologist are hence necessary to improve efficacy. Background and aims: Anti-obesity drugs are known to improve hepatic inflammation in patients with non-alcoholic fatty liver disease (NAFLD). We aimed to compare the effect of liraglutide and phentermine/topiramate in obese NAFLD patients. Method: We retrospectively enrolled 65 obese NAFLD patients without type 2 diabetes mellitus (liraglutide group [n = 30], phen-termine/topiramate group [n = 35]) who were treated with liraglutide or phentermine/topiramate for 12 months. Changes in laboratory data, body weight, degree of steatosis and fibrosis were compared between two groups. Steatosis was assessed using the fatty liver index, NAFLD liver fat score, and controlled attenuation parameter (CAP). Fibrosis was assessed using fibrosis index based on four factors (FIB4) and liver stiffness. Results: The mean body weight (80.3 ± 12.3 kg) and body mass index (29.4 ± 3.2) were similar between two groups. After 12 month of treatment, phentermine/topiramate group showed significantly greater effect in weight loss than liraglutide group (−8.4 ± 0.6 vs. −6.3 ± 0.4 kg, p = 0.003). Both group showed similar effect showing significant steatosis reduction (phentermine/topiramate vs. liraglu-tide; Δfatty liver index: −8.9 ± 2.3 vs. −8.4 ± 1.7, p = 0.449; ΔNAFLD liver fat score: −0.5 ± 0.2 vs. −0.4 ± 0.2, p = 0.835; ΔCAP: −9.2 ± 6.9 vs. −8.3 ± 4.6 dB/m 2 , p = 0.129). Fibrosis improvement was noted in bot
The effect of standard of care lifestyle advice by a hepatologist in a routine clinical practice on steatosis and fibrosis development among NAFLD patients
No full textBackground and aims: Weight loss through lifestyle modifications remains the mainstay for NAFLD treatment; however, implementing effective lifestyle interventions in clinical practice has been challenging due to time and cost constraints. Having a comprehensive approach to weight loss in patients with NAFLD that can be scaled and provided at low cost is a key unmet need. The objective of this study is to assess the effects of a mobile weight management program on weight loss and liver health biomarkers in adults with obesity and NAFLD. Method: Adults with obesity (BMI 30 to 49.9 kg/m 2 inclusive) and evidence of NAFLD based on Fibroscan CAP ≥274 dB/m were included. Patients were given access to the Noom Weight program for 16 weeks (midpoint) and then were followed for an additional 8 weeks (week 24 or end point). Measurements completed at baseline, midpoint, and end point included: weight/BMI, Fibroscan, routine labs (Complete Metabolic Panel and CBC), and the exploratory biomarker cytokeratin 18 fragment (CK18f). All tests of significance were performed at alpha = 0.05, two sided. Results: 40 subjects were enrolled and 82.5% (33/40) completed the study. The mean age was 55.9 years (range 29-79) with a mean BMI of 38 kg/m2 (30.5-49.8) and a mean baseline CAP score of 331.9 db/m 2 (276-396) and a mean LSM of 7.54 kPa (4.9-13.3). The average change in body weight from baseline was a 4.0% reduction and 32.4% (11/34) achieved total body weight reduction by 5% or more. There was a significant reduction in the CAP score by end point of 21.35 dB/ m (p = 0.024). The ALT decreased by 10 U/L or more in 27.3% (9/33). There was moderate correlation between BMI decrease and reduction in the CAP score (R = 0.533). There was no change in the LSM at the end point, and 62% (21) of subjects achieved >5% drop in CK18f. The change in CK18f correlated weakly (R = 0.215) with BMI drop but more strongly with Fibroscan CAP score (R = 0.468) and LSM (R = 0.764). Conclusion: The Noom Weight program had beneficial effects in patients with obesity and NAFLD, including significant reduction in the CAP score and one third of patients achieving 5% or more reduction in their weight. Steatosis of the liver was affected by weight loss as a result of engagement with the Noom Weight program. Fibrosis was not significantly affected by the Noom Weight program in the timeframe of the study. Fibrosis may require a longer timeframe for changes to be measured. FRI-526 The effect of standard of care lifestyle advice by a hepatologist in a routine clinical practice on steatosis and fibrosis development among NAFLD patients Background and aims: Non-alcoholic fatty liver disease (NAFLD) has become the most frequent cause of chronic liver disease. The leading cause of NAFLD has been defined as a behavioural phenotype comprising low physical activity and an obesogenic diet. The primary therapeutic advice is lifestyle changes leading to weight loss. Previous studies indicated that a weight reduction of 5% or more could induce regression of steatosis or fibrosis. However, hepatolo-gists only have time during consultations to give a short outline of the optimal lifestyle. As no data is available on the outcome of this routine practice, we evaluated the effect of this lifestyle advice on steatosis and fibrosis development among NAFLD patients. Figure: (abstract: FRI-524) The median change in clinic-laboratory parameters POSTER PRESENTATIONS S828 Journal of Hepatology 2023 vol. 78(S1) | S100-S1212 Method: Data were collected retrospectively using the electronic patient files of NAFLD patients in whom a baseline and a follow-up FibroScan® measurement (for assessment of steatosis by CAP™ and of liver stiffness (LSM) as a surrogate for fibrosis) were performed between November 2019 and 2022 at Ziekenhuis Oost-Limburg, Genk, Belgium. At the start, patients received Mediterranean diet related-advice, tips on improving exercise, and an information brochure concerning NAFLD from the hepatologist. Clinically meaningful weight loss was defined as a loss of at least 1 kg. Results: Of the 218 NAFLD patients evaluated, 130 (59.6%) were excluded due to the usage of semaglutide, not fasting, IQR/MED>30%, or bariatric surgery. In total, 88 (40.4%) patients were included, of whom 53 (60.2%) were men and 38 (43.2%) had type 2 diabetes mellitus (T2DM). The mean age, median BMI, and mean waist circumference were 54 ± 13 years, 31.0 (28.4-34.9) kg/m² and 105.2 ± 12.7 cm, respectively. On average, there were 186 (124-280) days between the measurements. The median weight loss between measurements was −1.2 (−4.1;1.4) kg. The decrease in LSM and CAP™ were −1.2 (−3.1;0.3) kPa and −7.0 (−50.5;8.8) dB/m, respectively. Within this group, 47 (53.4%) had clinically meaningful weight loss, while 41 (46.6%) did not lose any weight or gained weight. The group with weight loss developed a significantly (p 50 years), or having T2DM or not (p > 0.05). Conclusion: To the best of our knowledge, this is the first study to assess the effect of routine lifestyle advice by a hepatologist on body weight, steatosis, and fibrosis, measured by FibroScan®. The lifestyle advice leads to a weight reduction of at least −1 kg in almost half of NAFLD patients and a significant reduction in steatosis over six months in those patients. However, the recommended reduction in body weight (at least 5%) is not reached. Other measures to support the advice on lifestyle change given by the hepatologist are hence necessary to improve efficacy. Background and aims: Anti-obesity drugs are known to improve hepatic inflammation in patients with non-alcoholic fatty liver disease (NAFLD). We aimed to compare the effect of liraglutide and phentermine/topiramate in obese NAFLD patients. Method: We retrospectively enrolled 65 obese NAFLD patients without type 2 diabetes mellitus (liraglutide group [n = 30], phen-termine/topiramate group [n = 35]) who were treated with liraglutide or phentermine/topiramate for 12 months. Changes in laboratory data, body weight, degree of steatosis and fibrosis were compared between two groups. Steatosis was assessed using the fatty liver index, NAFLD liver fat score, and controlled attenuation parameter (CAP). Fibrosis was assessed using fibrosis index based on four factors (FIB4) and liver stiffness. Results: The mean body weight (80.3 ± 12.3 kg) and body mass index (29.4 ± 3.2) were similar between two groups. After 12 month of treatment, phentermine/topiramate group showed significantly greater effect in weight loss than liraglutide group (−8.4 ± 0.6 vs. −6.3 ± 0.4 kg, p = 0.003). Both group showed similar effect showing significant steatosis reduction (phentermine/topiramate vs. liraglu-tide; Δfatty liver index: −8.9 ± 2.3 vs. −8.4 ± 1.7, p = 0.449; ΔNAFLD liver fat score: −0.5 ± 0.2 vs. −0.4 ± 0.2, p = 0.835; ΔCAP: −9.2 ± 6.9 vs. −8.3 ± 4.6 dB/m 2 , p = 0.129). Fibrosis improvement was noted in bot
A significant decrease in steatosis using non-invasive measurements during monitoring for life style changes in patients with MASLD: interim 6 m results of a monocentric study
No full text[−50%]) and P3NP (−6.5 ng/ml [−40%]). Significant reductions were also observed in mean PRO-C3 (−6.1 ng/ml [−30%], p = 0.0002) and ELF score (−0.63 units, p = 0.008). A similar, but more attenuated, effect was observed in the 300 mg ICO treatment arm for all biomarkers (range −19 to −28% versus baseline), whereas the placebo arm showed no significant change in any variable (range −7 to +3% versus baseline). In alignment with the observed decrease in HbA1c, ICO treatment reduced mean FPG by 21% (p = 0.01) and 20% (p = 0.007) versus baseline for 300 mg and 600 mg respectively (placebo unchanged). Irrespective of T2D status, 82% (9/11) of fibrosis in the 600 mg treatment arm had a combined decrease in ALT of >17 U/L and ELF score >0.5 units versus 13% in non-responders. Conclusion: Once-daily, oral therapy with 600 mg ICO induces pronounced reductions in multiple elevated markers of liver injury and fibrosis in T2D MASH patients. Furthermore, a simultaneous decrease in ALT and ELF score may help identify histological responders to ICO therapy. SAT-196 A significant decrease in steatosis using non-invasive measurements during monitoring for life style changes in patients with MASLD: interim 6 m results of a monocentric study Background and aims: Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) is an important cause of chronic liver disease. Currently, the cornerstone of therapy is lifestyle modification (diet and exercise). Using paired liver biopsy studies, a weight reduction of more than 5% of body weight (BW) might be sufficient to reduce steatosis (at least one stage). This study investigates the outcome of a reduction of more than 5% of body weight (BW) on steatosis in patients with MASLD using non-invasive methods. Method: In this ongoing, monocentric (Ziekenhuis Oost Limburg, Genk, Belgium), prospective study patients with MASLD (Controlled Attenuation Parameter CAP TM ≥215 dB/m) are consecutively included since October 2022 to receive lifestyle intervention during 1 year. After 6 months (M6) and 1 year they are re-evaluated (clinical and biochemical evaluation, as well as liver stiffness measurement (LSM) by transient elastography (FibroScan ®) and CAP TM). Results: From October 2022 until December 2023, 297 patients were included. Their mean age was 52 ± 12 years, 47 % were female, 9 % had type 2 diabetes, 40 % metabolic syndrome, 53 % were living with obesity, 20 % were known with arterial hypertension. As of the 31st of December 2023, 111 patients presented at the M6 control visit: 41 (3
A significant decrease in steatosis using non-invasive measurements during monitoring for life style changes in patients with MASLD: interim 6 m results of a monocentric study
No full text[−50%]) and P3NP (−6.5 ng/ml [−40%]). Significant reductions were also observed in mean PRO-C3 (−6.1 ng/ml [−30%], p = 0.0002) and ELF score (−0.63 units, p = 0.008). A similar, but more attenuated, effect was observed in the 300 mg ICO treatment arm for all biomarkers (range −19 to −28% versus baseline), whereas the placebo arm showed no significant change in any variable (range −7 to +3% versus baseline). In alignment with the observed decrease in HbA1c, ICO treatment reduced mean FPG by 21% (p = 0.01) and 20% (p = 0.007) versus baseline for 300 mg and 600 mg respectively (placebo unchanged). Irrespective of T2D status, 82% (9/11) of fibrosis in the 600 mg treatment arm had a combined decrease in ALT of >17 U/L and ELF score >0.5 units versus 13% in non-responders. Conclusion: Once-daily, oral therapy with 600 mg ICO induces pronounced reductions in multiple elevated markers of liver injury and fibrosis in T2D MASH patients. Furthermore, a simultaneous decrease in ALT and ELF score may help identify histological responders to ICO therapy. SAT-196 A significant decrease in steatosis using non-invasive measurements during monitoring for life style changes in patients with MASLD: interim 6 m results of a monocentric study Background and aims: Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) is an important cause of chronic liver disease. Currently, the cornerstone of therapy is lifestyle modification (diet and exercise). Using paired liver biopsy studies, a weight reduction of more than 5% of body weight (BW) might be sufficient to reduce steatosis (at least one stage). This study investigates the outcome of a reduction of more than 5% of body weight (BW) on steatosis in patients with MASLD using non-invasive methods. Method: In this ongoing, monocentric (Ziekenhuis Oost Limburg, Genk, Belgium), prospective study patients with MASLD (Controlled Attenuation Parameter CAP TM ≥215 dB/m) are consecutively included since October 2022 to receive lifestyle intervention during 1 year. After 6 months (M6) and 1 year they are re-evaluated (clinical and biochemical evaluation, as well as liver stiffness measurement (LSM) by transient elastography (FibroScan ®) and CAP TM). Results: From October 2022 until December 2023, 297 patients were included. Their mean age was 52 ± 12 years, 47 % were female, 9 % had type 2 diabetes, 40 % metabolic syndrome, 53 % were living with obesity, 20 % were known with arterial hypertension. As of the 31st of December 2023, 111 patients presented at the M6 control visit: 41 (3
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
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