Low Awareness of Nonalcoholic Fatty Liver Disease Among Patients at High Metabolic Risk

Wieland, Amanda; Mettler, Pamela; McDermott, Michael T.; Crane, Lori A.; Cicutto, Lisa; Bambha, Kiran

doi:10.1097/mcg.0000000000000075

Cited by 69 publications

(66 citation statements)

References 4 publications

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“…Taken together, this pattern of care reflects low disease awareness among patients and providers, even in the face of multiple metabolic risk factors. 21,22 These care patterns also reflect perceptions regarding the clinical significance and treatment options for NAFLD held by many providers. 23 This low rate of referral to GI/Hepatology is in line with data from prior studies where 71% of providers reported that they did not refer patients with suspected NAFLD to GI/Hepatology.…”

Section: Discussionmentioning

confidence: 91%

“…Also of note, an additional one third of NAFLD patients were under the care of a GI provider for other conditions (eg, acid reflux and diarrhoea), but they did not receive care related to NAFLD. Taken together, this pattern of care reflects low disease awareness among patients and providers, even in the face of multiple metabolic risk factors . These care patterns also reflect perceptions regarding the clinical significance and treatment options for NAFLD held by many providers .…”

Section: Discussionmentioning

confidence: 91%

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Impact of a structured lifestyle programme on patients with metabolic syndrome complicated by non‐alcoholic fatty liver disease

Konerman

Walden

Joseph

et al. 2018

Aliment Pharmacol Ther

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Summary Background Lifestyle interventions are first‐line therapy for non‐alcoholic fatty liver disease (NAFLD). Aims To examine the prevalence of NAFLD among participants of the University of Michigan Metabolic Fitness (MetFit) Programme and to assess the impact of this programme on weight, metabolic and liver‐related parameters among patients with and without NAFLD. Methods Adults who completed the programme between 2008 and 2016 were included. Clinical and laboratory data were collected at enrolment, and at 12 and 24 weeks. NAFLD was defined based on liver biopsy, imaging or clinical diagnosis. Results The cohort (N = 403; 253 12‐week, 150 24‐week) consisted primarily of middle‐aged (median 54 years) white (88%) men (63%) with severe obesity (median BMI 37.4). 47.6% met criteria for NAFLD. At baseline, NAFLD patients were younger (52 vs 55 years), had higher weights and more metabolic derangements (higher fasting insulin and triglyceride, lower high‐density lipoprotein‐cholesterol). At programme completion, 30% achieved weight reduction ≥5%, 62% resolution of hypertriglyceridaemia, 33% resolution of low HDL, 27% resolution of impaired fasting glucose and 43% normalisation of alanine aminotransferase. Endpoints were unaffected by NAFLD. Longer programme duration (OR 6.7, 95% CI 3.6‐12.3) and white race (OR 3.83, 95% CI 1.04‐1.76) were independent predictors of ≥5% weight loss. Conclusions Nearly half of the patients referred to a structured lifestyle programme for metabolic syndrome had NAFLD. Although baseline metabolic derangements were more pronounced among NAFLD patients, the programme was equally efficacious in achieving weight loss and resolving metabolic syndrome components. Programme duration was the most important predictor of response.

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 91%

Impact of a structured lifestyle programme on patients with metabolic syndrome complicated by non‐alcoholic fatty liver disease

Konerman

Walden

Joseph

et al. 2018

Aliment Pharmacol Ther

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“…Compounding the problem, patients with NAFLD, and especially those with metabolic disturbances, have low awareness of NAFLD and its complications and management. 59 Furthermore, a recent study assessed NAFLD management in primary care settings and noted that the magnitude and proportion of ALT elevation was the only predictor of NAFLD care and only 3% of those with high risk of fibrosis were referred to a specialist. 60 All these findings imply that prompt changes are needed in surveillance strategy, management, and education of both patients and primary care providers taking care of patients at high risk of NAFLD, especially those with T2DM.…”

Section: Discussionmentioning

confidence: 99%

Non‐invasive screening of diabetics in primary care for NAFLD and advanced fibrosis by MRI and MRE

Doycheva

Cui

Nguyen

et al. 2015

Aliment Pharmacol Ther

185

134

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SUMMARY Background Current guidelines do not recommend screening for nonalcoholic fatty liver disease (NAFLD) or advanced fibrosis. Patients with type 2 diabetes mellitus (T2DM) are known to be at increased risk for NAFLD and advanced fibrosis. Aim We aimed to assess the feasibility in diabetics in a primary care setting of screening for NAFLD and advanced fibrosis by using non-invasive magnetic resonance imaging (MRI) to estimate the hepatic proton density fat fraction (MRI-PDFF) and magnetic resonance elastography (MRE) to estimate hepatic stiffness. Methods We performed a cross-sectional analysis of a prospective study that included 100 (53% men) consecutively enrolled diabetics who did not have any other etiology of liver disease. All patients underwent a standardized research visit, laboratory tests, MRI-PDFF, and MRE. Results Mean (± SD) age and BMI was 59.7 (±11.2) years and 30.8 (±6.5) kg/m2, respectively. The prevalence of NAFLD (defined as MRI-PDFF ≥ 5%) and advanced fibrosis (defined as MRE ≥ 3.6 kPa) was 65% and 7.1%, respectively. One patient with advanced fibrosis had definite hepatocellular carcinoma. When compared to those without NAFLD, patients with NAFLD were younger (p=0.028) and had higher mean BMI (p=0.0008), waist circumference (p<0.0001) and prevalence of metabolic syndrome (84.6% vs. 40.0%, p<0.0001). Only 26% of those with NAFLD had elevated ALT. Conclusions This proof-of-concept study demonstrates that T2DM has significant rates of both NAFLD and advanced fibrosis. Concomitant screening for NAFLD and advanced fibrosis by using MRI-PDFF and MRE in T2DM is feasible and may be considered after validation in a larger cohort.

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“…About 10% of the specialists used drugs to treat these conditions that were not recommended by the current guidelines [10]. This striking unawareness was also evident in another survey of 302 US patients in an outpatient clinical setting where only 18% of respondents were familiar with NAFLD and 67% of these patients were unaware that they had metabolic risk factors [11].…”

mentioning

confidence: 99%

Unmasking a Stealth Killer: The Need for Increased Awareness of NASH

Sherif

2019

Dig Dis Sci

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Low Awareness of Nonalcoholic Fatty Liver Disease Among Patients at High Metabolic Risk

Cited by 69 publications

References 4 publications

Impact of a structured lifestyle programme on patients with metabolic syndrome complicated by non‐alcoholic fatty liver disease

Impact of a structured lifestyle programme on patients with metabolic syndrome complicated by non‐alcoholic fatty liver disease

Non‐invasive screening of diabetics in primary care for NAFLD and advanced fibrosis by MRI and MRE

Unmasking a Stealth Killer: The Need for Increased Awareness of NASH

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