The Fatty Liver Assessment in Germany (FLAG) cohort study identifies large heterogeneity in NAFLD care

Abstract

A German real world NAFLD cohort Standard of care intervention Highlights This is the first report on NAFLD from a secondarycare real-world cohort in Germany. In this outpatient cohort, diagnostics rely heavily on non-invasive surrogate scores and elastography to stage NAFLD. Every 10th patient presents with advanced fibrosis at baseline. Management of NAFLD in Germany consists predominantly of general lifestyle recommendations and best supportive care. The study underlines the applicability of noninvasive tests to identify patients at risk of advanced fibrosis in secondary care in Germany. Lay summary FLAG is a real-world cohort study that examined the liver disease burden in secondary and tertiary care. Herein, 10% of patients referred to secondary care for NAFLD exhibited advanced liver disease, whilst 64% had no significant liver scarring. These findings underline the urgent need to define patient referral pathways for suspected liver disease.

The FibroScan-aspartate aminotransferase score can stratify the disease severity in a Japanese cohort with fatty liver diseases

“…Oeda et al analyzed 166 patients with biopsy-proven NAFLD 11 and found that approximately 25% of these patients fulfilled the histological criteria for progressive liver disease (NASH, NAS ≥ 4, and fibrosis score ≥ 2) 11 . Hofmann et al reported the characteristics and demographics of an observational NAFLD cohort in Germany 12 . In the subset using the FAST score (n = 107), 16.8%, 34.6%, and 48.6% of the patients were classified as rule in NASH, gray zone, and rule out NASH, respectively 12 .…”

“…Hofmann et al reported the characteristics and demographics of an observational NAFLD cohort in Germany 12 . In the subset using the FAST score (n = 107), 16.8%, 34.6%, and 48.6% of the patients were classified as rule in NASH, gray zone, and rule out NASH, respectively 12 . Puri et al investigated 199 United States veterans; among them, 29%, 36.5%, and 36.5% were classified as rule in NASH, gray zone, and rule out NASH, respectively 13 .…”

Differences between current clinical guidelines for screening, diagnosis and management of nonalcoholic fatty liver disease and real-world practice: a targeted literature review

“…Moreover, a qualitative study revealed low levels of patient education, support, and follow-up related to their diagnosis and implementation of lifestyle modification [59]. Poor understanding and inadequate support have been associated with low adherence to lifestyle modification programs among patients with NAFLD across Europe [78][79][80].…”

“…Overall, use of drugs otherwise indicated for the management of risk factors and that may improve liver pathology (e.g. metformin, glitazones, and statins), or other agent, including vitamin E, silymarin, phosphatidylcholine, and UDCA, was reported repeatedly: Asia [83], France [84], Germany [80], Poland [67], Romania [85], Russia [77] and the USA [86].…”

Neue Entwicklungen in der Diagnostik und Therapie der metabolisch assoziierten, nicht-alkoholischen Fettlebererkrankung

“…Einleitung/Epidemiologie Und Prognose Die Inzidenz und Prävalenz der nichtalkoholischen Fettleber (NAFLD) nimmt über die letzten Jahrzehnte weltweit rapide zu [1]. In Deutschland hat rund ein Viertel der Bevölkerung eine NAFLD [2], was eine zunehmende Belastung für das Gesundheitswesen darstellt. Somit ist die NAFLD in den letzten Jahren zur führenden chronischen Lebererkrankung in Deutschland avanciert.…”