Рабочая группа по диабету, предиабету и сердечно-сосудистым заболеваниям европейского общества кардиологов (ESC) в сотрудничестве с европейской ассоциацией по изучению диабета (EASD).

BACKGROUND Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of mortality in patients with nonalcoholic fatty liver disease (NAFLD). Weight loss is a key factor for successful NAFLD and CVD therapy. Ursodeoxycholic acid (UDCA), which is one of the first-line therapeutic agents for treatment of NAFLD, is reported to have a beneficial effect on dyslipidemia and ASCVD risk because of antioxidant properties. AIM To evaluate the effects of 6 mo of UDCA treatment on hepatic function tests, lipid profile, hepatic steatosis and fibrosis, atherogenesis, and ASCVD risk in men and women with NAFLD, as well as to assess the impact of > 5% weight reduction on these parameters. METHODS An open-label, multicenter, international noncomparative trial was carried out at primary health care settings and included 174 patients with ultrasound-diagnosed NAFLD who received 15 mg/kg/d UDCA for 6 mo and were prescribed lifestyle modification with diet and exercise. The efficacy criteria were liver enzymes, lipid profile, fatty liver index (FLI), noninvasive liver fibrosis tests (nonalcoholic fatty liver disease fibrosis score and liver fibrosis index), carotid intima-media thickness (CIMT), and ASCVD risk score. To test statistical hypotheses, the Wilcoxon test, paired t -test, Fisher’s exact test, and Pearson's chi-squared test were used. RESULTS The alanine aminotransferase (ALT) level changed by -14.1 U/L (-31.0; -5.3) from baseline to 3 mo and by -6.5 U/L (-14.0; 0.1) from 3 to 6 mo. The magnitude of ALT, aspartate transaminase, and glutamyltransferase decrease was greater during the first 3 mo of treatment compared to the subsequent 3 mo ( P < 0.001, P < 0.01, P < 0.001, respectively). At 6 mo, in the total sample, we observed a statistically significant decrease in body weight and levels of FLI: 84.9 ± 10.4 vs 72.3 ± 17.6, P < 0.001, total cholesterol: 6.03 ± 1.36 vs 5.76 ± 1.21, Р < 0.001, low-density lipoprotein: 3.86 ± 1.01 vs 3.66 ± 0.91, Р < 0.001, and triglyceride: 3.18 (2.00; 4.29) vs 2.04 (1.40; 3.16), Р < 0.001. No effect on nonalcoholic fatty liver disease fibrosis score or liver fibrosis index was found. The CIMT decreased significantly in the total sample (0.985 ± 0.243 vs 0.968 ± 0.237, P = 0.013), whereas the high-density lipoprotein ( Р = 0.036) and 10-year ASCVD risk ( Р = 0.003) improved significantly only in women. Fifty-four patients (31%) achieved > 5% weight loss. At the end of the study, the FLI decreased significantly in patients with (88.3 ± 10.2 vs ...

Aim: Little is known about the epidemiology of fatty liver disease (FLD) among high-risk primary care subjects in Kazakhstan. We investigated the prevalence of FLD (alcoholic liver disease [ALD] and non-alcoholic fatty liver disease [NAFLD]) and abnormal liver function tests (LFTs) in high risk adults in Kazakhstan during their routine visit to the general practitioner. Methods: This multicenter, cross-sectional epidemiological study was carried out at 75 clinical sites in the Republic of Kazakhstan. The full analysis set population consisted of 5109 subjects. Results: Among type 2 diabetes mellitus (T2DM) subjects, established metabolic syndrome (MetS) and/or obese subjects, the prevalence of FLD was 30.8%. LFT abnormalities were found in 53.2% subjects with FLD and 40.0% without FLD. FLD subjects had significantly higher levels of alanine transaminase (ALT; p < 0.001), aspartate transaminase (AST; p < 0.001), serum total bilirubin (STB; p < 0.001), and gamma-glutamyl transpeptidase (GGT; p = 0.021) compared to those without FLD. LFTs increases were significantly higher in subjects with FLD compared to those without FLD and were also significantly higher in ALD subjects compared to those with NAFLD. Conclusion: This study provides insights into the prevalence of FLD and abnormal LFTs in subjects with T2DM and/or established MetS and/or who are obese in primary care settings in Kazakhstan. These findings can help healthcare providers in Kazakhstan and elsewhere to better recognize and manage patients at risk of liver disease, which will improve clinical outcomes.

No abstract

Association for the Study of the Liver, Almaty c., Republic of Kazakhstan At present nonalcoholic fatty liver disease (NAFLD) is one of the most common internal diseases in hospital, leading to life quality deterioration, disability and mortality both for the reason, associated with concurrent cardiovascular diseases and components of metabolic syndrome and for the reason directly associated with a liver disease itself. Provided epidemiological cross sectional study-screening is focused on examination of NAFLD prevalence and associated components of metabolic syndrome in «theoretical» healthy individuals, i.e. office employees of Almaty city.