Consenso mexicano de la enfermedad por hígado graso no alcohólico

Bernal-Reyes, Raúl; Castro-Narro, Graciela; Malé-Velázquez, R.; Carmona-Sánchez, Ramón; González-Huezo, M.S.; García‐Juárez, Ignacio; Chávez-Tapia, Norberto C.; Aguilar-Salinas, C.; Aiza-Haddad, I.; Ballesteros-Amozurrutia, M.A.; Bosques-Padilla, Francisco; Castillo-Barradas, M.; Chávez-Barrera, J.A.; Cisneros-Garza, L.E.; Flores-Calderón, J.; García-Compeán, Diego; Gutiérrez-Grobe, Ylse; Tijera, M.F. Higuera de la; Kershenobich-Stalnikowitz, David; Guevara-Cetina, L. Ladrón de; Lizardi-Cervera, Javier; López-Cossio, J.A.; Martínez-Vázquez, Sophia E.; Márquez-Guillén, Ernesto; Méndez-Sánchez, Nahúm; Moreno-Alcántar, R.; Poo-Ramírez, J.L.; Ramos-Martínez, P.; Rodríguez-Hernández, Heriberto; Sánchez-Ávila, Juan Francisco; Stoopen-Rometti, M.; Torre-Delgadillo, Aldo; Torres‐Villalobos, Gonzalo; Trejo-Estrada, R.; Uribe, Misael; Velasco, J.A. Velarde-Ruiz

doi:10.1016/j.rgmx.2018.11.007

Cited by 29 publications

(13 citation statements)

References 271 publications

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“…Current expert recommendations [ 12 , 24 – 26 ] for evaluation of NAFLD in the primary care setting suggest initial risk stratification with FIB-4 or NAFLD fibrosis score, then referral of all at-risk patients for further evaluation and elastography. The test characteristics of FIB-4 and the NAFLD fibrosis score require further confirmatory testing if they are positive; there are a significant proportion of indeterminate tests that require further evaluation.…”

Section: Discussionmentioning

confidence: 99%

“…In F3 fibrosis, the dominant strategy was FIB-4 followed by shear wave elastography; shear wave elastography strategies correctly identified over 90% of advanced fibrosis. Current expert recommendations [12,[24][25][26] for evaluation of NAFLD in the primary care setting suggest initial risk stratification with FIB-4 or NAFLD fibrosis score, then referral of all at-risk patients for further evaluation and elastography. The test characteristics of FIB-4 and the NAFLD fibrosis score require further confirmatory testing if they are positive; there are a…”

Section: Discussionmentioning

confidence: 99%

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Modelling the cost effectiveness of non-alcoholic fatty liver disease risk stratification strategies in the community setting

2021

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Background Non-alcoholic fatty liver disease (NAFLD) is highly prevalent worldwide. Identifying high-risk patients is critical to best utilize limited health care resources. We established a community-based care pathway using 2D ultrasound shear wave elastography (SWE) to identify high risk patients with NAFLD. Our objective was to assess the cost-effectiveness of various non-invasive strategies to correctly identify high-risk patients. Methods A decision-analytic model was created using a payer’s perspective for a hypothetical patient with NAFLD. FIB-4 [≥1.3], NAFLD fibrosis score (NFS) [≥-1.455], SWE [≥8 kPa], transient elastography (TE) [≥8 kPa], and sequential strategies with FIB-4 or NFS followed by either SWE or TE were compared to identify patients with either significant (≥F2) or advanced fibrosis (≥F3). Model inputs were obtained from local data and published literature. The cost/correct diagnosis of advanced NAFLD was obtained and univariate sensitivity analysis was performed. Results For ≥F2 fibrosis, FIB-4/SWE cost $148.75/correct diagnosis while SWE cost $276.42/correct diagnosis, identifying 84% of patients correctly. For ≥F3 fibrosis, using FIB-4/SWE correctly identified 92% of diagnoses and dominated all other strategies. The ranking of strategies was unchanged when stratified by normal or abnormal ALT. For ≥F3 fibrosis, the cost/correct diagnosis was less in the normal ALT group. Conclusions SWE based strategies were the most cost effective for diagnosing ≥F2 fibrosis. For ≥F3 fibrosis, FIB-4 followed by SWE was the most effective and least costly strategy. Further evaluation of the timing of repeating non-invasive strategies are required to enhance the cost-effective management of NAFLD.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Modelling the cost effectiveness of non-alcoholic fatty liver disease risk stratification strategies in the community setting

2021

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“…Si el tratamiento inicial no muestra resultados satisfactorios, se suelen incluir también tratamientos farmacológicos en individuos con índice de masa corporal (IMC) ≥30 kg/m² y en aquellos con IMC ≥27 kg/m² con comorbilidades [17], [20].…”

Section: Tratamiento Actualunclassified

Abordaje Preventivo en La Enfermedad Por Hígado Graso No Alcohólico

LÓPEZ-ALMADA¹,

Domínguez-Ávila

González‐Aguilar

et al. 2022

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La obesidad es actualmente un problema de salud pública a nivel mundial. Ésta se caracteriza por afectar a múltiples órganos, entre ellos el hígado, desarrollándose enfermedades como la enfermedad de hígado graso no alcohólico (EHGNA), la cual predispone al desarrollo de carcinoma hepatocelular. En esta revisión se discute la asociación entre la obesidad y la EHGNA, enfatizando un abordaje preventivo y de intervención en etapas tempranas de la enfermedad, así como los potenciales efectos de algunos compuestos bioactivos presentes en la dieta. Al respecto es recomendable centrar la intervención en mejorar el IMC, a través de un programa de actividad física, educación nutricional y de salud, y cambios en los patrones dietéticos. La inclusión de alimentos ricos en compuestos bioactivos, como los compuestos fenólicos, fibra y vitaminas pueden proveer de un efecto antioxidante, antiinflamatorio y anti-obesogénico que podrían obstaculizar la progresión de la EHGNA, y otras comorbilidades y complicaciones.

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“…La forma más común a nivel mundial de esteatosis hepática es la enfermedad por hígado graso no alcohólica (EHGNA), y México no tiene un panorama distinto, afecta al 30-40% de los hombres y al 15-20% de las mujeres en la población general 2 .…”

Section: Introductionunclassified