scholarly journals Implementation of a care bundle improves the management of patients with non-alcoholic fatty liver disease

2021 ◽  
pp. flgastro-2020-101480
Author(s):  
Laura Jane Neilson ◽  
Louise Macdougall ◽  
Phey Shen Lee ◽  
Timothy Hardy ◽  
David Beaton ◽  
...  
Keyword(s):  
Risk Factors ◽  
Liver Disease ◽  
Fatty Liver ◽  
Fatty Liver Disease ◽  
Metabolic Risk Factors ◽  
Care Bundle ◽  
Metabolic Risk ◽  
Lifestyle Advice ◽  
Alcoholic Fatty Liver ◽  
Alcoholic Fatty Liver Disease

BackgroundNon-alcoholic fatty liver disease (NAFLD) is common and is associated with liver-related and cardiovascular-related morbidity. Our aims were: (1) to review the current management of patients with NAFLD attending hospital clinics in North East England (NEE) and assess the variability in care; (2) develop a NAFLD ‘care bundle’ to standardise care; (3) to assess the impact of implementation of the NAFLD care bundle.MethodsA retrospective review was conducted to determine baseline management of patients with NAFLD attending seven hospitals in NEE. A care bundle for the management of NAFLD was developed including important recommendations from international guidelines. Impact of implementation of the bundle was evaluated prospectively in a single centre.ResultsBaseline management was assessed in 147 patients attending gastroenterology, hepatology and a specialist NAFLD clinic. Overall, there was significant variability in the lifestyle advice given and management of metabolic risk factors, with patients attending an NAFLD clinic significantly more likely to achieve >10% body weight loss and have metabolic risk factors addressed. Following introduction of the NAFLD bundle 50 patients were evaluated. Use of the bundle was associated with significantly better documentation and implementation of most aspects of patient management including management of metabolic risk factors, documented lifestyle advice and provision of NAFLD-specific patient advice booklets.ConclusionThe introduction of an outpatient ‘care bundle’ led to significant improvements in the assessment and management of patients with NAFLD in the NEE and could help improve and standardise care if used more widely.

scholarly journals Evidence based literature review of clinical management of non-alcoholic fatty liver disease in real world settings

2017 ◽  
Vol 6 (5) ◽  
pp. 1020
Author(s):  
Gourdas Choudhuri ◽  
Varun Gupta
Keyword(s):  
Risk Factors ◽  
Liver Disease ◽  
Fatty Liver ◽  
Lifestyle Intervention ◽  
Real World ◽  
Fatty Liver Disease ◽  
Metabolic Risk Factors ◽  
Metabolic Risk ◽  
Alcoholic Fatty Liver ◽  
Alcoholic Fatty Liver Disease

The aim of the present review is to understand the gap between real world clinical practices, guidelines recommendations and to propose minimum essentials that can be followed in clinical practice in NAFLD patients in India. A detailed literature search of published medical reports in English language was performed on electronic databases such as PubMed and Cochrane, from 2000 to 2016 using relevant search terms. The search yielded 25 relevant articles whose full texts were retrieved and evaluated. Non-alcoholic fatty liver disease (NAFLD) is an emerging cause of liver disease in India. It is observed that physicians under appreciate the overlap between NAFLD and metabolic risk factors, thus missing a significant proportion of high-risk NAFLD patients. Lifestyle intervention is generally considered the first line therapy for patients with NAFLD without steatohepatitis while pharmacotherapy (in addition to lifestyle intervention) is suggested for patients with non-alcoholic steatohepatitis (NASH). Current therapies are directed towards improving the metabolic parameters which contribute to disease pathogenesis. Pharmacological therapies for NAFLD and NASH include antioxidants such as vitamin E and ursodeoxycholic acid; insulin sensitizers such as metformin and thiazolidinones, weight loss drugs like orlistat and consideration of bariatric surgery for morbidly obese patients. High degree of suspicion is necessary for diagnosing NAFLD in patients with metabolic risk factors. Further studies are required from India as genotype/clinico-pathological profile of Indian NAFLD patients differ from the western population. Further, prospective studies will fill the various missing links associated with management of NAFLD in Indian patients in a more effective manner.

scholarly journals Comparative analysis of metabolic risk factors for progression of non-alcoholic fatty liver disease

2021 ◽  
Vol 7 (2) ◽  
pp. 241-247
Author(s):  
Vincent J. H. Yao ◽  
Michael Sun ◽  
Aivi A. Rahman ◽  
Zachariah Samuel ◽  
Joyce Chan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Liver Disease ◽  
Comparative Analysis ◽  
Fatty Liver ◽  
Fatty Liver Disease ◽  
Metabolic Risk Factors ◽  
Metabolic Risk ◽  
Alcoholic Fatty Liver ◽  
Alcoholic Fatty Liver Disease

Abstract P395: Non-Alcoholic Fatty Liver Disease in a Lean Population is Associated with Hypertension Independent of Metabolic Risk Factors

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Adil Karim ◽  
Pragya Sinha ◽  
Ehimen Aneni ◽  
Ebenezer T Oni ◽  
Michael J Blaha ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Liver Disease ◽  
Fatty Liver ◽  
Fatty Liver Disease ◽  
Density Lipoprotein ◽  
Metabolic Risk Factors ◽  
Metabolic Risk ◽  
Alcoholic Fatty Liver ◽  
Nonalcoholic Fatty Liver

Introduction: Hypertension is the most common causal risk factor for coronary artery disease. The increased prevalence of hypertension in those with nonalcoholic fatty liver disease (NAFLD) is well studied. Less well studied is the prevalence of hypertension in lean (BMI<25) individuals with NAFLD. This warrants attention since the burden of cardiovascular disease is increasingly shifting to the lean. Methods: The data for this study was obtained from a cohort of 6464 Brazilians (41.4+/-9 Y, 62% M) free of diabetes mellitus or cardiovascular disease. Of these, 39% (n=2508) were lean (BMI<25). Hypertension was defined as systolic BP (SBP) ≥ 140 mmHg or DBP ≥90 mmHg, self-identification as hypertensive or being on medication for hypertension. NAFLD was diagnosed using ultrasound in those with <20g/d alcohol intake. Results: The prevalence of hypertension in the lean population was nine percent. NAFLD was significantly associated with the presence of hypertension. The prevalence of hypertension was 16% and 8% in those with and without NAFLD respectively (p<0.001). In a multivariate analysis controlling for age, gender, triglyceride and high density lipoprotein cholesterol, the risk of hypertension in those with NAFLD was 1.54 times those without NAFLD(p<0.001). Conclusion: There is significantly increased prevalence of hypertension in lean, healthy individuals with NAFLD. This association is present even after adjusting for age, gender and metabolic risk factors. This relationship needs to be explored further since an increasing number of lean individuals have NAFLD on examination (Younossi et al., 2012).

scholarly journals Non-alcoholic fatty liver disease in polycystic ovary syndrome women

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Young Bin Won ◽  
Seok Kyo Seo ◽  
Bo Hyon Yun ◽  
SiHyun Cho ◽  
Young Sik Choi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Liver Disease ◽  
Fatty Liver ◽  
Liver Enzyme ◽  
Fatty Liver Disease ◽  
Polycystic Ovary ◽  
Insulin Level ◽  
University Hospital ◽  
Alcoholic Fatty Liver ◽  
Alcoholic Fatty Liver Disease

AbstractTo evaluate risk factors leading to non-alcoholic fatty liver disease (NAFLD) occurrence in polycystic ovarian syndrome (PCOS) women. A retrospective cohort study of a total of 586 women diagnosed with PCOS aged 13–35 years at the gynecology department at a university hospital was done to evaluate PCOS phenotype, metabolic syndrome (MetS) diagnosis, body composition, insulin sensitivity, sex hormones, lipid profile, liver function, and transient elastography (TE). In PCOS women with NAFLD compared to those without, MetS diagnosis (Hazard ratio [HR] 5.6, 95% Confidence interval [CI] 2.2–14.4, p < 0.01) and hyperandrogenism (HA) (HR 4.4, 95% CI 1.4–13.4, p = 0.01) were risk factors significantly associated with subsequent NAFLD occurrence, whereas 2-h insulin level in 75 g glucose tolerance test (GTT) (HR 1.2, 95% CI 0.5–2.5, p = 0.70) and body mass index (BMI) > 25 kg/m2 (HR 2.2, 95% CI 0.6–8.0, p = 0.24) was not. Among NAFLD patients who underwent TE, a higher number of MetS components indicated a worse degree of fibrosis and steatosis. MetS diagnosis and HA at PCOS diagnosis were risk factors associated with NAFLD, while 2-h insulin level in 75 g GTT and obesity were not. Although elevated aspartate aminotransferase levels were significant for NAFLD risk, liver enzyme elevations may not be present until late liver damage. Further prospective studies of PCOS women with MetS or HA are warranted to determine whether patients without liver enzyme elevations should undergo preemptive liver examinations.

Sign in / Sign up

Export Citation Format

Share Document