The Prevalence and Determinants of NAFLD and MAFLD and Their Severity in the VA Primary Care Setting

Thrift, Aaron P.; Nguyen, Theresa; Pham, Codey; Balakrishnan, Maya; Kanwal, Fasiha; Loomba, Rohit; Duong, Hao T.; Ramsey, David J.; El–Serag, Hashem B.

doi:10.1016/j.cgh.2022.05.046

Cited by 8 publications

(7 citation statements)

References 25 publications

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“…Although the reasons are unclear, diabetes and hyperlipidemia are associated with vascular dementia, independent of liver disease. 18 , 19 , 20 Depression and PTSD, which are known to be occur more often among people with cirrhosis than the general population, were not associated with high FIB-4 scores in this analysis. This apparent lack of association may have been due to controlling for AUD, which may mediate the associations between PTSD, depression, and cirrhosis.…”

Section: Discussioncontrasting

confidence: 55%

“…While some traditional risk factors, such as AUD and viral hepatitis, were associated with high FIB-4 scores, others (eg, diabetes and hyperlipidemia) were not. Although the reasons are unclear, diabetes and hyperlipidemia are associated with vascular dementia, independent of liver disease . Depression and PTSD, which are known to be occur more often among people with cirrhosis than the general population, were not associated with high FIB-4 scores in this analysis.…”

Section: Discussionmentioning

confidence: 57%

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Undiagnosed Cirrhosis and Hepatic Encephalopathy in a National Cohort of Veterans With Dementia

Bajaj,

Silvey,

Rogal

et al. 2024

JAMA Netw Open

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ImportanceDementia and hepatic encephalopathy (HE) are challenging to distinguish clinically. Undiagnosed cirrhosis in a patient with dementia can lead to missed opportunities to treat HE.ObjectiveTo examine the prevalence and risk factors of undiagnosed cirrhosis and therefore possible HE in veterans with dementia.Design, Setting, and ParticipantsA retrospective cohort study was conducted between 2009 and 2019 using data from the Veterans Health Administration (VHA) and 2 separate validation cohorts from the Richmond Veterans Affairs Medical Center. Data analysis was conducted from May 20 to October 15, 2023. Participants included 177 422 US veterans with a diagnosis of dementia at 2 or more clinic visits, no prior diagnosis of cirrhosis, and with sufficient laboratory test results to calculate the Fibrosis-4 (FIB-4) score.ExposuresDemographic and clinical characteristics.Main Outcomes and MeasuresAn FIB-4 score (&gt;2.67 suggestive of advanced fibrosis and &gt;3.25 suggestive of cirrhosis), capped at age 65 years even for those above this cutoff who were included in the analysis.ResultsAmong 177 422 veterans (97.1% men; 80.7% White; mean (SD) age, 78.35 [10.97] years) 5.3% (n = 9373) had an FIB-4 score greater than 3.25 and 10.3% (n = 18 390) had an FIB-4 score greater than 2.67. In multivariable logistic regression models, FIB-4 greater than 3.25 was associated with older age (odds ratio [OR], 1.07; 95% CI, 1.06-1.09), male gender (OR, 1.43; 95% CI, 1.26-1.61), congestive heart failure (OR, 1.48; 95% CI, 1.43-1.54), viral hepatitis (OR, 1.79; 95% CI, 1.66-1.91), Alcohol Use Disorders Identification Test score (OR, 1.56; 95% CI, 1.44-1.68), and chronic kidney disease (OR, 1.11; 95% CI, 1.04-1.17), and inversely associated with White race (OR, 0.79; 95% CI, 0.73-0.85), diabetes (OR, 0.78; 95% CI, 0.73-0.84), hyperlipidemia (OR, 0.84; 95% CI, 0.79-0.89), stroke (OR, 0.85; 95% CI, 0.79-0.91), tobacco use disorder (OR, 0.78; 95% CI, 0.70-0.87), and rural residence (OR, 0.92; 95% CI, 0.87-0.97). Similar findings were associated with the FIB-4 greater than 2.67 threshold. These codes were associated with cirrhosis on local validation. A local validation cohort of patients with dementia showed a similar percentage of high FIB-4 scores (4.4%-11.2%).Conclusions and RelevanceThe findings of this cohort study suggest that clinicians encountering patients with dementia should be encouraged to screen for cirrhosis using the FIB-4 score to uncover reversible factors associated with cognitive impairment, such as HE, to enhance outcomes.

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Section: Discussioncontrasting

confidence: 55%

Section: Discussionmentioning

confidence: 57%

Undiagnosed Cirrhosis and Hepatic Encephalopathy in a National Cohort of Veterans With Dementia

Bajaj,

Silvey,

Rogal

et al. 2024

JAMA Netw Open

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“…A recent study in a veterans population in primary care settings demonstrated 100% concordance between the two definitions. 50 In addition, a meta-analysis including data from 17 studies comprising 9 808 677 individuals showed that the prevalence of MAFLD was comparable to the prevalence of NAFLD. Only 4.0% of patients with NAFLD did not meet the MAFLD criteria.…”

Section: Does the Change To Mafld Impact The Performance Of Non-invas...mentioning

confidence: 99%

“…52 53 Similarly, patients diagnosed according to the new criteria for multiple sclerosis displayed a lower risk of reaching disability. 50 In the field of drug development, one example is the change in diagnostic criteria for eosinophilic esophagitis implemented in 2018 that removed the proton pump inhibitor (PPI) use requirement for a diagnosis of coexisting eosinophilic esophagitis and gastrooesophageal reflux disease. Previous requirement for PPI trial stemmed from the belief that both entities were mutually exclusive.…”

Section: Does the Change To Mafld Impact The Performance Of Non-invas...mentioning

confidence: 99%

Two years on, a perspective on MAFLD

Eslam,

George

2023

egastro

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To provide clarity for research studies and clinical care, a set of positive criteria for adults and children with metabolic (dysfunction) associated fatty liver disease (MAFLD) was recently published and has subsequently been widely endorsed. The development and subsequent validation of the criteria for MAFLD has created a positive momentum for change. During the course of the ongoing discussion on the redefinition, some concerns have surfaced that we thought needs clarification. In this review, we provide a perspective on MAFLD and bringing clarity to some of the key aspects that have been recently raised.

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“…Metabolic (dysfunction)-associated fatty liver disease (MAFLD) is a condition characterized by the build-up of fat in the liver, in the presence of overweight/obesity, type 2 diabetes, or at least two metabolic risk abnormalities that would indicate metabolic dysregulation (e.g., high waist circumference, elevated blood pressure, high triglycerides, low HDL, prediabetes) [1]. While the debate about which term to use is still ongoing, [2,3] recent studies indicate that there is high agreement between the MAFLD and non-alcoholic fatty liver disease (NAFLD) definitions, with this agreement potentially dropping as the prevalence of the underlying etiologies changes [4][5][6]. Regardless, the prevalence of both MAFLD and NAFLD is high in the United States population [4] and concerted efforts are needed to address disease pathogenesis and to inform primary and secondary prevention strategies.…”

Section: Introductionmentioning

confidence: 99%

Association of Diet Quality with Metabolic (Dysfunction) Associated Fatty Liver Disease in Veterans in Primary Care

et al. 2023

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Background: Diet is associated with metabolic (dysfunction)-associated fatty liver disease (MAFLD), but the dietary composition associated with MAFLD risk has not been well-examined. Aim: The purpose of this study was to assess the association of two healthy eating indices with the presence and severity of MAFLD in a sample of Veterans in a primary care setting. Methods: This was a single center cross-sectional study using a random stratified sample of Veterans enrolled in primary care. Participants underwent a Fibroscan and completed an interviewer-administered Diet History Questionnaire II from which we calculated the Healthy Eating Index-2015 and Alternate Mediterranean Diet Score. We used multivariable logistic regression models to assess associations of dietary quality with MAFLD. Results: We analyzed data from 187 participants, 53.5% of whom were female. On average, participants were 50.2 years of age (SD, 12.3 years) with an average BMI of 31.7 kg/m2. MAFLD was detected in 78 (42%) and at least moderate fibrosis in 12 (6%) participants. We found that the Alternate Mediterranean Diet Score was inversely associated with MAFLD (adjusted OR = 0.85, 95%CI 0.72–1.00), but controlling for BMI and total energy intake attenuated the association (adjusted OR = 0.92, 95%CI 0.74–1.15). We found no statistically significant associations between the Healthy Eating Index-2015 and MAFLD or advanced fibrosis. Discussion: We found that the Alternate Mediterranean Diet Score was significantly associated with lower MAFLD risk in Veterans; however, the association was mediated by BMI and total energy intake. A Mediterranean-style diet could potentially help reduce the risk of MAFLD, particularly if it helps control total energy intake and weight.

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The Prevalence and Determinants of NAFLD and MAFLD and Their Severity in the VA Primary Care Setting

Cited by 8 publications

References 25 publications

Undiagnosed Cirrhosis and Hepatic Encephalopathy in a National Cohort of Veterans With Dementia

Undiagnosed Cirrhosis and Hepatic Encephalopathy in a National Cohort of Veterans With Dementia

Two years on, a perspective on MAFLD

Association of Diet Quality with Metabolic (Dysfunction) Associated Fatty Liver Disease in Veterans in Primary Care

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