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Risk factors for biopsy-proven advanced non-alcoholic fatty liver disease in the Veterans Health Administration.

Publication ,  Journal Article
Patel, YA; Gifford, EJ; Glass, LM; McNeil, R; Turner, MJ; Han, B; Provenzale, D; Choi, SS; Moylan, CA; Hunt, CM
Published in: Aliment Pharmacol Ther
January 2018

BACKGROUND: With its increasing incidence, nonalcoholic fatty liver disease (NAFLD) is of particular concern in the Veterans Health Administration (VHA). AIMS: To evaluate risk factors for advanced fibrosis in biopsy-proven NAFLD in the VHA, to identify patients at risk for adverse outcomes. METHODS: In randomly selected cases from VHA databases (2005-2015), we performed a retrospective case-control study in adults with biopsy-defined NAFLD or normal liver. RESULTS: Of 2091 patients reviewed, 399 met inclusion criteria. Normal controls (n = 65) had normal liver function. The four NAFLD cohorts included: NAFL steatosis (n = 76), nonalcoholic steatohepatitis (NASH) without fibrosis (n = 68), NAFLD/NASH stage 1-3 fibrosis (n = 82), and NAFLD/NASH cirrhosis (n = 70). NAFLD with hepatocellular carcinoma (HCC) was separately identified (n = 38). Most patients were older White men. NAFLD patients with any fibrosis were on average severely obese (BMI>35 kg/m2 ). Diabetes (54.4%-79.6%) and hypertension (85.8%-100%) were more common in NAFLD with fibrosis or HCC. Across NAFLD, 12.3%-19.5% were enrolled in diet/exercise programs and 0%-2.6% had bariatric surgery. Hispanics exhibited higher rates of NASH (20.6%), while Blacks had low NAFLD rates (1.4%-11.8%), particularly NAFLD cirrhosis and HCC (1.4%-2.6%). Diabetes (OR 11.8, P < .001) and BMI (OR 1.4, P < .001) were the most significant predictors of advanced fibrosis. CONCLUSIONS: In the VHA, diabetes and severe obesity increased risk for advanced fibrosis in NAFLD. Of these patients, only a small proportion (~20%) had enrolled in diet/exercise programs or had bariatric surgery (~2%). These results suggest that providers should focus/tailor interventions to improve outcomes, particularly in those with diabetes and severe obesity.

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Published In

Aliment Pharmacol Ther

DOI

EISSN

1365-2036

Publication Date

January 2018

Volume

47

Issue

2

Start / End Page

268 / 278

Location

England

Related Subject Headings

  • Veterans Health
  • Veterans
  • United States Department of Veterans Affairs
  • United States
  • Severity of Illness Index
  • Risk Factors
  • Retrospective Studies
  • Non-alcoholic Fatty Liver Disease
  • Middle Aged
  • Male
 

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Patel, Y. A., Gifford, E. J., Glass, L. M., McNeil, R., Turner, M. J., Han, B., … Hunt, C. M. (2018). Risk factors for biopsy-proven advanced non-alcoholic fatty liver disease in the Veterans Health Administration. Aliment Pharmacol Ther, 47(2), 268–278. https://doi.org/10.1111/apt.14411
Patel, Y. A., E. J. Gifford, L. M. Glass, R. McNeil, M. J. Turner, B. Han, D. Provenzale, S. S. Choi, C. A. Moylan, and C. M. Hunt. “Risk factors for biopsy-proven advanced non-alcoholic fatty liver disease in the Veterans Health Administration.Aliment Pharmacol Ther 47, no. 2 (January 2018): 268–78. https://doi.org/10.1111/apt.14411.
Patel YA, Gifford EJ, Glass LM, McNeil R, Turner MJ, Han B, et al. Risk factors for biopsy-proven advanced non-alcoholic fatty liver disease in the Veterans Health Administration. Aliment Pharmacol Ther. 2018 Jan;47(2):268–78.
Patel, Y. A., et al. “Risk factors for biopsy-proven advanced non-alcoholic fatty liver disease in the Veterans Health Administration.Aliment Pharmacol Ther, vol. 47, no. 2, Jan. 2018, pp. 268–78. Pubmed, doi:10.1111/apt.14411.
Patel YA, Gifford EJ, Glass LM, McNeil R, Turner MJ, Han B, Provenzale D, Choi SS, Moylan CA, Hunt CM. Risk factors for biopsy-proven advanced non-alcoholic fatty liver disease in the Veterans Health Administration. Aliment Pharmacol Ther. 2018 Jan;47(2):268–278.
Journal cover image

Published In

Aliment Pharmacol Ther

DOI

EISSN

1365-2036

Publication Date

January 2018

Volume

47

Issue

2

Start / End Page

268 / 278

Location

England

Related Subject Headings

  • Veterans Health
  • Veterans
  • United States Department of Veterans Affairs
  • United States
  • Severity of Illness Index
  • Risk Factors
  • Retrospective Studies
  • Non-alcoholic Fatty Liver Disease
  • Middle Aged
  • Male