With the growing prevalence of obesity and diabetes in the United States and across the world, a rise in the overall incidence and prevalence of non-alcoholic fatty liver disease (NAFLD) is expected. The risk factors for NAFLD are also associated with the development of chronic kidney disease (CKD). We review the epidemiology, risk factors, genetics, implications of gut dysbiosis, and specific pathogenic mechanisms linking NAFLD to CKD. Mechanisms such as ectopic lipid accumulation, cellular signaling abnormalities, and the interplay between fructose consumption and uric acid accumulation have led to the emergence of potential therapeutic implications for this patient population. Transplant evaluation in the setting of both NAFLD and CKD is also reviewed. Potential strategies for surveillance and management include the monitoring of comorbidities, the use of non-invasive fibrosis scoring systems, and the measurement of laboratory markers. Lastly, we discuss the management of patients with NAFLD and CKD, from preventative measures to experimental interventions.

Background Perioperative smoking is associated with an increased incidence of general postoperative morbidity and mortality. The perioperative period is recognized as an important “teachable moment” that can motivate patients to adopt health changing behaviors. Objective In this study, we aimed to determine the prevalence of smokers among elective surgical patients in an Asian tertiary hospital. We also investigated their smoking characteristics, previous quitting attempts, readiness-to-quit status as well as knowledge of smoking-related postoperative complications. Methods We conducted a single-center prospective cohort study among all patients who attended a preoperative assessment clinic within a 2-month period (August to September 2020) using a preoperative smoking questionnaire. Results A total of 3362 patients participated in the study, of which 348 (10.4%) were current smokers. More than half (65.6%) of the smokers had previously attempted to quit smoking, with most (78%) having made more than one attempt. Forty-nine percent of current smokers were in the pre-contemplation stage of quitting and thirty-one percent were in the contemplation stage. Only twenty-one percent were in the preparation stage of quitting. Thirty-eight percent of patients recognized the importance of smoking cessation perioperatively but only twenty-eight percent were confident of quitting perioperatively. Less than sixty percent of smokers were aware of at least one type of smoking-related postoperative complication. Less than half of the patients (45%) had ever received advice on perioperative smoking cessation from the surgeons. Conclusion A thorough understanding of smokers’ smoking characteristics, barriers to quit and readiness-to-quit status are crucial to establishing a successful multidisciplinary perioperative smoking cessation program. Counselling should address knowledge deficits and be tailored to a patient’s stage-of-change in order to seize this precious perioperative “teachable moment”.

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INTRODUCTION: Nonalcoholic fatty liver disease (NAFLD) refers to the presence of hepatic steatosis in the absence of significant alcohol consumption. It is the most common liver disease in Western industrialized countries, characterized by excessive accumulation of triglycerides in hepatocytes. The spectrum of conditions ranges from benign hepatic steatosis to nonalcoholic steatohepatitis (NASH), fibrosis, cirrhosis, and increased risk of hepatocellular carcinoma (HCC). There has been limited study of Asian Americans with NAFLD comparing to the other races. Our study aims to assess the racial difference in clinical features of NAFLD patients. METHODS: We conducted a retrospective chart review of patients age ≥ 18 years and < 90 years with NAFLD followed at Sandra Atlas Bass Center for Liver Disease from 2013 to 2018. Patients with co-existing chronic liver disease or significant alcohol consumption (men > 21 drinks/week, women > 14 drinks/week) were excluded. Clinical data including demographics, anthropometrics, comorbidities, laboratory results, Fibrosis-4 (FIB-4) index, and FibroScan were collected and analyzed. Analysis of variance and Pearson’s chi-squared test were used to analyze continuous variables and categorical variables, respectively. RESULTS: We identified 342 patients with NAFLD. We analyzed 289 patients including 209 Caucasians (72.3%), followed by 38 Hispanics (13.2%), 26 Asian Americans (9%), and 16 African Americans (5.5%). There is no difference in age, gender, aspartate aminotransferase (AST), alanine aminotransferase (ALT), lipid profile, blood pressure, steatosis score, FIB-4 index, and fibrosis stage among these four groups. However, Asians are less likely to be obese (26% BMI ≥ 30, vs. 66.5%, 62.5% and 60.5% for Caucasians, Africans, and Hispanics, respectively; P = 0.001); yet, they are more likely to have elevated hemoglobin A1c (HA1c) (100% with HA1c >5.6% vs. 63.3%, 62.5% and 84% for Caucasians, Africans, and Hispanics, respectively; P = 0.0002). CONCLUSION: Our study suggests that Asian Americans with the diagnosis of NAFLD are less likely to be obese but are more likely to have elevated hemoglobin A1c compared to the other racial groups. The difference observed in this study raises the possibility that the Asian Americans may be different from that among the other racial/ethnic groups in the pathogenesis of NAFLD. Further research is warranted to assess the detailed relationship and possible mechanisms between HA1c and NAFLD.