Burden of nonalcoholic fatty liver disease and advanced fibrosis in a Texas Hispanic community cohort

AIM: To investigate the potential burden of nonalcoholic steatohepatitis(NASH) and advanced fibrosis in a hispanic community.METHODS: Four hundred and forty two participants with available ultrasonography data from the Cameron County Hispanic Cohort were included in this study. Each participant completed a comprehensive questionnaire regarding basic demographic information, medical history, medication use, and social and family history including alcohol use. Values of the nonalcoholic fatty liver disease fibrosis score(NFS), FIB4 index, BARD score, and Aspartate aminotransferase to Platelet Ratio Index(APRI) were computed using the blood samples collected within 6 mo of liver ultrasonography from each participant. Hepatic steatosis was determined by ultrasonography. As part of univariable analysis, for continuous variables, comparisons among groups were performed with student-t test, one way analysis of variance, and Mann-Whitney test. Pearson χ2 and the Fisher exact test are used to assess differences in categorical variables. For multivariable analyses, logistic regression analyses were performed to identify characteristics associated with hepatic steatosis. All reported P values are based two-sided tests, and a P value of less than 0.05 was considered to indicate statistical significance.RESULTS: The mean age and body mass index(BMI) of the study participants were 49.1 years and 31.3 kg/m2, respectively. Among them, 65.6% were females, 52% had hepatic steatosis, 49.5% had metabolic syndrome, and 29% had elevated aminotransferases. Based on established cut-offs for diagnostic panels, between 17%-63% of the entire cohort was predicted to have NASH with indeterminate or advanced fibrosis. Participants with hepatic steatosis had significantly higher BMI(32.9 ± 5.6 kg/m2 vs 29.6 ± 6.1 kg/m2, P < 0.001) and higher prevalence rates of elevation of ALT(42.2% vs 14.6%, P < 0.001), elevation of aspartate aminotransferase(38.7% vs 18.9%, P < 0.001), and metabolic syndrome(64.8% vs 33%, P < 0.001) than those without hepatic steatosis. The NFS scores(P = 0.002) and the APRI scores(P = 0.002) were significantly higher in those with steatosis but the scores of the FIB4 index and BARD were similar between the two groups. After adjusting for age, gender and BMI, elevated transaminases, metabolic syndrome and its components, intermediate NFS and APRI scores were associated hepatic steatosis in multivariable analysis. CONCLUSION: The burden of NASH and advanced fibrosis in the Hispanic community in South Texas may be more substantial than predicted from referral clinic studies.

Chronic hepatitis B infection in pregnancy

There are no standard guidelines to follow when a patient with chronic hepatitis B infection becomes pregnant or desires pregnancy. Topics to consider include which patients to treat, when to start treatment, what treatment to use and when to stop treatment. Without any prophylaxis or antiviral therapy, a hepatitis B surface antigen and E antigen positive mother has up to a 90% likelihood of vertical transmission of hepatitis B virus(HBV) to child. Standard of care in the United States to prevent perinatal transmission consists of administration of hepatitis B immune globulin and HBV vaccination to the infant. The two strongest risk factors of mother to child transmission(MTCT) of HBV infection despite immunoprophylaxis are high maternal HBV viral load and high activity of viral replication. The goal is to prevent transmission of HBV at birth by decreasing viral load and/or decreasing activity of the virus. Although it is still somewhat controversial, most evidence shows that starting antivirals in the third trimester is effective in decreasing MTCT without affecting fetal development. There is a growing body of literature supporting the safety and efficacy of antiviral therapies to reduce MTCT of hepatitis B. There are no formal recommendations regarding which agent to choose. Tenofovir, lamivudine and telbivudine have all been proven efficacious in decreasing viral load at birth without known birth defects, but final decision of which antiviral medication to use will have to be determined by physician and patient. The antivirals may be discontinued immediately if patient is breastfeeding, or within first four weeks if infant is being formula fed.

Gender and racial differences in nonalcoholic fatty liver disease

Due to the worldwide epidemic of obesity, nonalcoholic fatty liver disease(NAFLD) has become the most com-mon cause of elevated liver enzymes. NAFLD represents a spectrum of liver injury ranging from simple steato-sis to nonalcoholic steatohepatitis(NASH) which may progress to advanced fibrosis and cirrhosis. Individuals with NAFLD, especially those with metabolic syndrome, have higher overall mortality, cardiovascular mortality, and liver-related mortality compared with the general population. According to the population-based studies, NAFLD and NASH are more prevalent in males and in Hispanics. Both the gender and racial ethnic differences in NAFLD and NASH are likely attributed to interaction between environmental, behavioral, and genetic fac-tors. Using genome-wide association studies, several genetic variants have been identified to be associated with NAFLD/NASH. However, these variants account for only a small amount of variation in hepatic steatosis among ethnic groups and may serve as modifiers of the natural history of NAFLD. Alternatively, these variants may not be the causative variants but simply markers representing a larger body of genetic variations. In this article, we provide a concise review of the gender and racial differences in the prevalence of NAFLD and NASHin adults. We also discuss the possible mechanisms for these disparities.

无征状的主要胆汁的肝硬化没与心血管的疾病的增加的频率被联系

AIM:To estimate the prevalence of cardiovascular events in Primary biliary cirrhosis(PBC) and to determine whether this risk is higher within specific subgroups of patients with PBC. METHODS:We included 180 patients with PBC(cases) and 151 patients seen for HCV infection(controls) .Medical records were reviewed and statistical analyses were performed as appropriate. RESULTS:When compared to controls,PBC patients were older,leaner and had higher serum levels of total cholesterol,high density lipoprotein and low density cholesterol.There were more females in the PBC group(91.7%vs 43%,P【0.001) .More control subjects had smoked than the PBC patients(63.6%vs 35%,P 【0.001) .The prevalence of hypertension,diabetes,coronary artery disease and stroke was similar between the two groups.Seven percent of controls and 10%of cases developed any type of cardiovascular disease(P =0.3) .Only 36.7%were asymptomatic at diagnosis. Three cardiovascular events were documented amongasymptomatic patients(4.5%) and fifteen among symptomatic patients(13.2%;P=0.06) .Among PBC patients with fatigue,10(13.5%) had a cardiovascular event compared to 7(6.7%) among patients without fatigue(P=0.1) . CONCLUSION:Asymptomatic PBC patients do not have a greater frequency of cardiovascular disease;nor do patients suffering with fatigue.