Cardiovascular risk profile in patients with hepatic steatosis (original) (raw)
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Assessment of hepatic steatosis algorithms in non-alcoholic fatty liver disease
PubMed, 2018
Background: In order to optimize the identification of persons with non-alcoholic fatty liver disease (NAFLD), several algorithms for hepatic steatosis were developed. These available algorithms, as well as an algorithm, derived using biochemical and anthropometric data of our participants, are compared in a cross-sectional pilot study. Material and methods: We included 77 participants with abdominal obesity: 43 with NAFLD and 33 without NAFLD. Body mass index (BMI), waist circumference (WC) and hip circumference (HC), systolic and diastolic blood pressure were assessed. Fibrinogen, high sensitive C-reactive protein (hsCRP), aspartate aminotransferase (AST), alanine transaminase (ALT), gamma-glutamyl transferase (GGT), uric acid, ferritin, glucose, insulin, homocysteine, lipid status parameters, apolipoprotein A-I, apolipoprotein B and Lp(a)-lipoprotein were measured. Fatty liver was assessed by ultrasound with the presence or absence of hepatic steatosis. Discovering the most significant factor in the presence of NAFLD is assessed through logistic regression modeling. The predictor variables were chosen according to an algorithm derived from conducted factor analysis and other available algorithms for hepatic steatosis. Results: Participants with NAFLD had significantly higher BMI (34.38 ± 9.73 vs 28.05 ± 4.79 kg/m2, p =0.001), WC (108.05 ± 11.47 vs 96.15 ± 14.27 cm, p =0.001), HC (114.93 ± 11.01 vs 108.21 ± 9.82 cm, p =0.050), systolic (128.98 ± 8.67 vs 122.42 ± 10.62 mmHg, p =0.010) and diastolic blood pressure (83.64 ± 5.94 vs 78.33 ± 7.57 mmHg, p =0.001), AST (23.93 ± 6.91 vs 21.70 ± 5.21 U/L, p =0.014), ALT (30.50 ± 13.70 vs 23.00 ± 11.75 U/L, p =0.007), hsCRP (4.34 ± 5.56 vs 2.98 ± 2.34mg/l, p =0.004) and uric acid (358.02 ± 83.29 vs 296.78 ± 84.54µmol/l, p =0.001), in comparison non NAFLD. Logistic regression model with algorithm derived from factor analysis showed the best performance. From other available algorithms, only fatty liver index (FLI) and hepatic steatosis index (HSI) had statistically significant discriminatory power. Conclusions: Elevation of WC, HC, BMI, DBP, SBP, Fbg, hsCRP, glucose, and uric acid, incorporated in our hepatic steatosis prediction model, had the best predictive power among all assessed algorithms. HIPPOKRATIA 2018, 22(1): 10-16.
BMC gastroenterology, 2006
Fatty liver (FL) is the most frequent liver disease in Western countries. We used data from the Dionysos Nutrition & Liver Study to develop a simple algorithm for the prediction of FL in the general population. 216 subjects with and 280 without suspected liver disease were studied. FL was diagnosed by ultrasonography and alcohol intake was assessed using a 7-day diary. Bootstrapped stepwise logistic regression was used to identify potential predictors of FL among 13 variables of interest [gender, age, ethanol intake, alanine transaminase, aspartate transaminase, gamma-glutamyl-transferase (GGT), body mass index (BMI), waist circumference, sum of 4 skinfolds, glucose, insulin, triglycerides, and cholesterol]. Potential predictors were entered into stepwise logistic regression models with the aim of obtaining the most simple and accurate algorithm for the prediction of FL. An algorithm based on BMI, waist circumference, triglycerides and GGT had an accuracy of 0.84 (95%CI 0.81-0.87) i...
Hepatology Communications, 2019
Cardiovascular diseases (CVDs) are the leading cause of mortality in patients with nonalcoholic fatty liver disease (NAFLD). Our aim was to assess the association of atherosclerotic cardiovascular disease (ASCVD) risk scores with overall and cardiac-specific mortality among patients with NAFLD. We used the National Health and Nutrition Examination Survey III with the National Death Index-linked mortality files. NAFLD was defined by ultrasound as presence of steatosis in the absence of secondary causes of liver disease. High risk for CVD was defined as a 10-year ASCVD score ≥7.5%. Hazard ratios (HRs) and population-attributable fractions (PAFs) of high risk for CVD were calculated. Among 1,262 subjects with NAFLD (47.9% men; 41.2% white; mean age, 56.3 years), the prevalence of high risk for CVD was 55.9% and 4.8% had advanced fibrosis. After a median follow-up of 17.7 years, 482 subjects (38.2%) died of overall causes, of whom 382 (79.3%) had a high risk for CVD. The unadjusted over...
Medical Journal of the Islamic Republic of Iran, 2020
Background: Non-alcoholic steatohepatitis (NASH) is increasing worldwide due to the metabolic syndrome epidemy. According to the current evidence, a higher cardiovascular disease risk (CVDR) is observed in NASH individuals than the general population. Objective: The relationship between liver fat content (LFC) and CVDR in a cohort of NASH patients was evaluated in this research. Methods: Consecutively selected patients with increased aminotransferase levels and fatty change in liver ultrasonography were enrolled in the study. Those with known causes of viral hepatitis, any hepatotoxic medications or alcohol consumption, autoimmune hepatitis, cigarette smoking, and ischemic heart disease were excluded from the project. The remaining was presumed to have NASH. The Framingham risk score (FRS) and LFC were calculated by means of an online calculator and a valid formula, respectively. The correlation between LFC and independent variables was measured using the Pearson correlation test. T...
BMJ open, 2014
We investigated if the differences in liver fat content would predict the development of non-fatal and fatal atherosclerotic endpoints (coronary heart disease and stroke). Our study group is a population-based, randomly recruited cohort (Oulu Project Elucidating Risk of Atherosclerosis, OPERA), initiated in 1991. The cohort consisted of 988 middle-aged Finnish participants. Total mortality and hospital events were followed up to 2009 based on the registry of the National Institute for Health and Welfare and the National death registry. The severity of hepatic steatosis was measured by ultrasound and divided into three groups (0-2). Cox regression analysis was used in the statistical analysis. In the follow-up of years 1991-2009, 13.5% of the participants with non-fatty liver, 24.2% of participants having moderate liver fat content and 29.2% of the participants having severe fatty liver experienced a cardiovascular event during the follow-up time (p<0.001). Severe liver fat conten...
Atherosclerosis, 2009
Backgrounds: Nonalcoholic fatty liver disease (NAFLD) has been linked to cardiovascular disease (CVD) but it is largely unknown if such a relationship between NAFLD and CVD risk relates to severity of liver disease or if it is independent. We aimed to study the severity of NAFLD in a well characterized non-obese population and to compare this to prevalence of CVD risk factors and Framingham risk score. Methods: This study included 30,172 subjects. Based on the presence or absence of steatosis on ultrasound and serum alanine aminotransferase (ALT), subjects were divided into controls, an increased serum ALT group without steatosis and a group with presumed nonalcoholic fatty liver disease (NAFLD), which included a steatosis alone group and a group with presumed nonalcoholic steatohepatitis (NASH) with steatosis and an elevated ALT. Results: The odds ratio for 10-year risk by total Framingham risk scores ≥10% was 5.3 times higher in NASH groups. The prevalence of diabetes, hypertension, elevated CRP and metabolic syndrome were all increased up to 15-fold over controls, independent of age, BMI, smoking and exercise habits. Overall CVD risk was significantly greater in NASH than in either steatosis or raised ALT alone. Conclusion: Young, non-obese subjects with NAFLD are at significantly increased CVD risk, especially those with NASH. As well as specific therapy for liver disease, a diagnosis of NAFLD should lead to targeted risk assessment and risk factor modification.
Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 2019
Background: Insulin resistance (IR) in cases of non-alcoholic fatty liver disease (NAFLD) is connected to remarkable liver cell inflammation and cardiovascular complications. Given the prevalence of NAFLD and its association with potential sequels, there is a strong need for an accurate non-invasive tool to monitor the progression of NAFLD. Methods: 272 patients with NAFLD and cardio-metabolic risk factors were tested for HOMA-IR, mean platelet volume (MPV), neutrophil-lymphocyte ratio (NLR), uric acid, ferritin, lipid profile, liver stiffness measurement (LSM), controlled attenuation parameter (CAP) by fibroscan and carotid intima media thickness (CIMT). Liver biopsy was performed to validate the results.100 healthy controls were selected. A score was constructed and applied to a validation group (n ¼ 61). Results: Logistic regression revealed that significant fibrosis and cardiovascular risk in NAFLD were independently associated with AST/ALT ratio (p ¼ 0.000), GGT (p ¼ 0.000), CIMT (p ¼ 0.001), uric acid (p ¼ 0.000), VLDL (p ¼ 0.000), HOMA-IR (p ¼ 0.000), ferritin (p ¼ 0.000) CAP (p ¼ 0.000), LSM (p0.000). A non-invasive model was formulated by which a value > 15 was accurate in identification of advanced fibrosis and cardiovascular risk with a sensitivity of 97.3%, specificity 97%. Conclusion: The score correlated well with the results of liver biopsy and can be repeated with great flexibility to assess severity of NAFLD.
BMJ open gastroenterology, 2018
Hepatic fibrosis in patients with non-alcoholic fatty liver disease (NAFLD) independently predicts mortality. Given liver biopsy's invasive nature, non-invasive method to assess hepatic steatosis and fibrosis provides NAFLD risk stratification algorithm in clinical practice. NAFLD fibrosis score (NFS) is simple and non-invasive predictive model recommended by American Association for the Study of Liver Disease (AASLD) Guideline to identify patients with NAFLD with fibrosis risk. The aim of this study is to assess long-term outcomes of subjects with significant non-alcoholic steatofibrosis (NASF) as established by ultrasound (US) and NFS. Used National Health and Nutrition Examination Survey (NHANES III) with National Death Index-linked Mortality Files. NAFLD diagnosis established by the presence of moderate to severe hepatic steatosis on US without other causes of chronic liver disease (alcohol consumption <20 gr/day, hepatitis B surface-antigen negative, anti-hepatitis C vir...