Biomarkers for High-Risk Nonalcoholic Fatty Liver Disease: Beyond Portal Venous Pulsatility Index

Abstract Individuals with type 2 diabetes (T2DM) are at high risk for nonalcoholic fatty liver disease (NAFLD), and evidence suggests that poor glycemic control is linked to heightened risk of progressive NAFLD. We conducted an observational study based on data from a telehealth trial conducted in 2018-2020. Our objectives were to: 1) characterize patterns of NAFLD testing/care in a cohort of individuals with poorly-controlled T2DM; and 2) explore how lab-based measures of NAFLD (e.g., liver enzymes, fibrosis-4 [FIB-4]) vary by glycemic control. We included individuals with poorly-controlled T2DM (n=228), defined as hemoglobin A1c (HbA1c) ≥ 8.5% despite clinic-based care. Two groups of interest were: 1) T2DM without known NAFLD; and 2) T2DM with known NAFLD. Demographics, medical history, medication use, glycemic control (HbA1c) and NAFLD testing/care patterns were obtained by chart review. Among those without known NAFLD (n=213), most were male (78.4%) and self-identified as Black race (68.5%). Mean HbA1c was 9.8%. Most had liver enzymes (85.4%) and platelets (84.5%) ordered outpatient over a 2-year period that would allow for FIB-4 calculation, yet only 2 individuals had FIB-4 documented in clinical notes. Approximately one third had abnormal liver enzymes at least once over a 2-year period, yet only 7% had undergone liver ultrasound and 4.7% had referral placed to Hepatology. Among those with known NAFLD (n=15), mean HbA1c was 9.5%. Only 4 individuals had undergone transient elastography, half of whom had advanced fibrosis. NAFLD is underrecognized in poorly-controlled T2DM, even though this is a high-risk group for NAFLD and its complications.

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The Epidemiology, Risk Profiling and Diagnostic Challenges of Nonalcoholic Fatty Liver Disease

Medicines ◽

10.3390/medicines6010041 ◽

2019 ◽

Vol 6 (1) ◽

pp. 41 ◽

Cited By ~ 25

Author(s):

Umair Iqbal ◽

Brandon Perumpail ◽

Daud Akhtar ◽

Donghee Kim ◽

Aijaz Ahmed

Keyword(s):

Metabolic Syndrome ◽

Liver Disease ◽

High Risk ◽

Environmental Factors ◽

Fatty Liver ◽

Nonalcoholic Fatty Liver Disease ◽

Liver Damage ◽

Fatty Liver Disease ◽

Active Management ◽

Nonalcoholic Fatty Liver

Nonalcoholic fatty liver disease (NAFLD) encompasses a wide spectrum of liver damage from the more prevalent (75%–80%) and nonprogressive nonalcoholic fatty liver (NAFL) category to its less common and more ominous subset, nonalcoholic steatohepatitis (NASH). NAFLD is now the most common cause of chronic liver disease in the developed world and is a leading indication for liver transplantation in United States (US). The global prevalence of NAFLD is estimated to be 25%, with the lowest prevalence in Africa (13.5%) and highest in the Middle East (31.8%) and South America (30.4%). The increasing incidence of NAFLD has been associated with the global obesity epidemic and manifestation of metabolic complications, including hypertension, diabetes, and dyslipidemia. The rapidly rising healthcare and economic burdens of NAFLD warrant institution of preventative and treatment measures in the high-risk sub-populations in an effort to reduce the morbidity and mortality associated with NAFLD. Genetic, demographic, clinical, and environmental factors may play a role in the pathogenesis of NAFLD. While NAFLD has been linked with various genetic variants, including PNPLA-3, TM6SF2, and FDFT1, environmental factors may predispose individuals to NAFLD as well. NAFLD is more common in older age groups and in men. With regards to ethnicity, in the US, Hispanics have the highest prevalence of NAFLD, followed by Caucasians and then African-Americans. NAFLD is frequently associated with the components of metabolic syndrome, such as type 2 diabetes mellitus (T2DM), obesity, hypertension, and dyslipidemia. Several studies have shown that the adoption of a healthy lifestyle, weight loss, and pro-active management of individual components of metabolic syndrome can help to prevent, retard or reverse NAFLD-related liver damage. Independently, NAFLD increases the risk of premature cardiovascular disease and associated mortality. For this reason, a case can be made for screening of NAFLD to facilitate early diagnosis and to prevent the hepatic and extra-hepatic complications in high risk sub-populations with morbid obesity, diabetes, and other metabolic risk factors.

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Metabolic dysfunction‐associated fatty liver disease and nonalcoholic fatty liver disease: Which can better identify the populations with a high risk of cardiovascular disease?

Hepatology Research ◽

10.1111/hepr.13717 ◽

2021 ◽

Vol 51 (11) ◽

pp. 1097-1099

Author(s):

Sachiyo Yoshio

Keyword(s):

Cardiovascular Disease ◽

Liver Disease ◽

High Risk ◽

Fatty Liver ◽

Nonalcoholic Fatty Liver Disease ◽

Fatty Liver Disease ◽

Metabolic Dysfunction ◽

Nonalcoholic Fatty Liver

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Abstract C090: Community-based screening for nonalcoholic fatty liver disease with transient elastography in Latinos without overt liver disease at high risk of hepatocellular carcinoma

10.1158/1538-7755.disp19-c090 ◽

2020 ◽

Author(s):

Shehnaz Hussain ◽

Jihane Benhammou

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Disease ◽

High Risk ◽

Fatty Liver ◽

Nonalcoholic Fatty Liver Disease ◽

Fatty Liver Disease ◽

Transient Elastography ◽

Community Based ◽

Nonalcoholic Fatty Liver

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Nonalcoholic Fatty Liver Disease: Epidemiology, Pathogenesis, Natural History, Diagnosis, and Current Treatment Options

Clinical Medicine Insights Therapeutics ◽

10.4137/cmt.s18885 ◽

2016 ◽

Vol 8 ◽

pp. CMT.S18885 ◽

Cited By ~ 5

Author(s):

Bubu A. Banini ◽

Arun J. Sanyal

Keyword(s):

Liver Disease ◽

High Risk ◽

Fatty Liver ◽

Nonalcoholic Fatty Liver Disease ◽

Fatty Liver Disease ◽

Treatment Options ◽

Current Treatment ◽

Nonalcoholic Fatty Liver ◽

Disease Epidemiology ◽

Advanced Phase

Nonalcoholic fatty liver disease (NAFLD) is on the rise and has become a major etiology for chronic liver disease. It is frequently associated with obesity, insulin resistance, hypertension, and dyslipidemia and is considered the hepatic manifestation of metabolic syndrome. In this review, we present a summary of the epidemiology and pathogenesis of NAFLD, and discuss the clinical evaluation and stratification of NAFLD patients into low, intermediate, and high risk with respect to liver-related outcomes. While diet and exercise are the cornerstone of treatment in all patients, the low rate of adherence and inadequacy of these recommendations necessitate pharmacologic intervention, especially in intermediate- and high-risk patients. We discuss vitamin E and pioglitazone which are often used as first-line therapy by many practitioners, with pentoxifylline and liraglutide as backup agents. Several drugs are in advanced-phase clinical trials and will likely change the landscape for management of NAFLD in the very near future.

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