Background:The recently introduced set of terminologies defining categories of steatotic liver disease(SLD)includes metabolic dysfunction-associated SLD(MASLD),alcohol-associated liver disease(ALD),and metabolic dysfu...Background:The recently introduced set of terminologies defining categories of steatotic liver disease(SLD)includes metabolic dysfunction-associated SLD(MASLD),alcohol-associated liver disease(ALD),and metabolic dysfunction associated steatotic liver disease and increased alcohol intake(MetALD).The present retrospective cohort study examines clinical characteristics,prevalence,and mortality risk across alcoholic intake spectrum in SLD individuals.Methods:Data between 1999 to 2018 were extracted from National Health and Nutrition Examination Survey registries and analysed.Population baseline characteristics were evaluated across classifications of SLD.SLD was confirmed using either fatty liver index(FLI)or United States FLI(US-FLI).Multivariate analyses were used to study mortality-related outcomes.Results:The 20,510 individuals with SLD included were classified into MASLD predominant(69.00%),MetALD(18.77%),and ALD predominant(12.23%)groups.Temporal analysis revealed significant decreases in MASLD prevalence in the SLD population from 1999-2018 in general[average annual percentage change(AAPC)−4.802%,P=0.001],as well as in females,Mexican Americans,and Non-Hispanic Blacks.MetALD prevalence in the SLD population increased from 1999-2018 in general(AAPC+1.635%,P<0.001),and in males,females,Mexican Americans,Non-Hispanic Blacks and other ethnicities.No significant change in ALD prevalence was found.Compared to MASLD predominant individuals,ALD predominant individuals had higher risks of all-cause[hazard ratio(HR):1.189,95%confidence interval(CI):1.026 to 1.378,P=0.02]and cancer-related mortality(subdistribution HR:1.277,95%CI:1.032 to 1.579,P=0.02).No significant difference was observed for all-cause,cancer-related,or cardiovascular disease(CVD)-related mortality in MetALD and CVD-related mortality in ALD predominant individuals,relative to MASLD predominant individuals.Conclusions:ALD predominant patients have higher all-cause and cancer-related mortality risks than MASLD predominant patients but not CVD-related mortality.SLD is highly heterogeneous in clinical characteristics,prevalence,and mortality risks which healthcare professionals must account for to avert adverse health outcomes.展开更多
Background:Outcomes after liver resection(LR)and liver transplantation(LT)for hepatocellular carcinoma(HCC)are heterogenous and may vary by region,over time periods and disease burden.We aimed to compare overall survi...Background:Outcomes after liver resection(LR)and liver transplantation(LT)for hepatocellular carcinoma(HCC)are heterogenous and may vary by region,over time periods and disease burden.We aimed to compare overall survival(OS)and disease-free survival(DFS)between LT versus LR for HCC within the Milan criteria.Methods:Two authors independently searched Medline and Embase databases for studies comparing survival after LT and LR for patients with HCC meeting the Milan criteria.Meta-analyses and meta-regression were conducted using random-effects models.Results:We screened 2,278 studies and included 35 studies with 18,421 patients.LR was associated with poorer OS[hazard ratio(HR)=1.44;95%confidence interval(CI):1.14-1.81;P<0.01]and DFS(HR=2.71;95%CI:2.23-3.28;P<0.01)compared to LT,with similar findings among intention-to-treat(ITT)studies.In uninodular disease,OS in LR was comparable to LT(P=0.13)but DFS remained poorer(HR=2.95;95%CI:2.30-3.79;P<0.01).By region,LR had poorer OS versus LT in North America and Europe(P≤0.01),but not Asia(P=0.25).LR had inferior survival versus LT in studies completed before 2010(P=0.01),but not after 2010(P=0.12).Cohorts that underwent enhanced surveillance had comparable OS after LT and LR(P=0.33),but cohorts undergoing usual surveillance had worse OS after LR(HR=1.95;95%CI:1.24-3.07;P<0.01).Conclusions:Mortality after LR for HCC is nearly 50%higher compared to LT.Survival between LR and LT were similar in uninodular disease.The risk of recurrence after LR is threefold that of LT.展开更多
Background:Bariatric surgery represents an important treatment option for severely obese patients with nonalcoholic fatty liver disease(NAFLD).However,there remains inadequate data regarding the effects of different b...Background:Bariatric surgery represents an important treatment option for severely obese patients with nonalcoholic fatty liver disease(NAFLD).However,there remains inadequate data regarding the effects of different bariatric procedures on various NAFLD parameters,especially for histological outcomes.Thus,this meta-analysis aimed to compare the effects of restrictive bariatric procedures and foregut bypass on the metabolic,biochemical,and histological parameters for patients with NAFLD.Methods:Medline and Embase were searched for articles relating to bariatric procedures and NAFLD.Pairwise meta-analysis was conducted to compare efficacy of bariatric procedures pre-vs.post-procedure with subgroup analysis to further compare restrictive against foregut bypass procedures.Results:Thirty-one articles involving 3,355 patients who underwent restrictive bariatric procedures(n=1,460)and foregut bypass(n=1,895)were included.Both foregut bypass(P<0.01)and restrictive procedures(P=0.03)significantly increased odds of fibrosis resolution.Compared to restrictive procedures,foregut bypass resulted in a borderline non-significant decrease in fibrosis score(P=0.06)and significantly lower steatosis score(P<0.001).For metabolic parameters,foregut bypass significantly lowered body mass index(P=0.003)and low-density lipoprotein(P=0.008)compared to restrictive procedures.No significant differences were observed between both procedures for aspartate aminotransferase(P=0.17)and alkaline phosphatase(P=0.61).However,foregut bypass resulted in significantly lower gamma-glutamyl transferase than restrictive procedures(P=0.01)while restrictive procedures resulted in significantly lower alanine transaminase than foregut bypass(P=0.02).Conclusions:The significant histological and metabolic advantages and comparable improvements in biochemical outcomes support the choice of foregut bypass over restrictive bariatric procedures in NAFLD management.展开更多
文摘Background:The recently introduced set of terminologies defining categories of steatotic liver disease(SLD)includes metabolic dysfunction-associated SLD(MASLD),alcohol-associated liver disease(ALD),and metabolic dysfunction associated steatotic liver disease and increased alcohol intake(MetALD).The present retrospective cohort study examines clinical characteristics,prevalence,and mortality risk across alcoholic intake spectrum in SLD individuals.Methods:Data between 1999 to 2018 were extracted from National Health and Nutrition Examination Survey registries and analysed.Population baseline characteristics were evaluated across classifications of SLD.SLD was confirmed using either fatty liver index(FLI)or United States FLI(US-FLI).Multivariate analyses were used to study mortality-related outcomes.Results:The 20,510 individuals with SLD included were classified into MASLD predominant(69.00%),MetALD(18.77%),and ALD predominant(12.23%)groups.Temporal analysis revealed significant decreases in MASLD prevalence in the SLD population from 1999-2018 in general[average annual percentage change(AAPC)−4.802%,P=0.001],as well as in females,Mexican Americans,and Non-Hispanic Blacks.MetALD prevalence in the SLD population increased from 1999-2018 in general(AAPC+1.635%,P<0.001),and in males,females,Mexican Americans,Non-Hispanic Blacks and other ethnicities.No significant change in ALD prevalence was found.Compared to MASLD predominant individuals,ALD predominant individuals had higher risks of all-cause[hazard ratio(HR):1.189,95%confidence interval(CI):1.026 to 1.378,P=0.02]and cancer-related mortality(subdistribution HR:1.277,95%CI:1.032 to 1.579,P=0.02).No significant difference was observed for all-cause,cancer-related,or cardiovascular disease(CVD)-related mortality in MetALD and CVD-related mortality in ALD predominant individuals,relative to MASLD predominant individuals.Conclusions:ALD predominant patients have higher all-cause and cancer-related mortality risks than MASLD predominant patients but not CVD-related mortality.SLD is highly heterogeneous in clinical characteristics,prevalence,and mortality risks which healthcare professionals must account for to avert adverse health outcomes.
文摘Background:Outcomes after liver resection(LR)and liver transplantation(LT)for hepatocellular carcinoma(HCC)are heterogenous and may vary by region,over time periods and disease burden.We aimed to compare overall survival(OS)and disease-free survival(DFS)between LT versus LR for HCC within the Milan criteria.Methods:Two authors independently searched Medline and Embase databases for studies comparing survival after LT and LR for patients with HCC meeting the Milan criteria.Meta-analyses and meta-regression were conducted using random-effects models.Results:We screened 2,278 studies and included 35 studies with 18,421 patients.LR was associated with poorer OS[hazard ratio(HR)=1.44;95%confidence interval(CI):1.14-1.81;P<0.01]and DFS(HR=2.71;95%CI:2.23-3.28;P<0.01)compared to LT,with similar findings among intention-to-treat(ITT)studies.In uninodular disease,OS in LR was comparable to LT(P=0.13)but DFS remained poorer(HR=2.95;95%CI:2.30-3.79;P<0.01).By region,LR had poorer OS versus LT in North America and Europe(P≤0.01),but not Asia(P=0.25).LR had inferior survival versus LT in studies completed before 2010(P=0.01),but not after 2010(P=0.12).Cohorts that underwent enhanced surveillance had comparable OS after LT and LR(P=0.33),but cohorts undergoing usual surveillance had worse OS after LR(HR=1.95;95%CI:1.24-3.07;P<0.01).Conclusions:Mortality after LR for HCC is nearly 50%higher compared to LT.Survival between LR and LT were similar in uninodular disease.The risk of recurrence after LR is threefold that of LT.
文摘Background:Bariatric surgery represents an important treatment option for severely obese patients with nonalcoholic fatty liver disease(NAFLD).However,there remains inadequate data regarding the effects of different bariatric procedures on various NAFLD parameters,especially for histological outcomes.Thus,this meta-analysis aimed to compare the effects of restrictive bariatric procedures and foregut bypass on the metabolic,biochemical,and histological parameters for patients with NAFLD.Methods:Medline and Embase were searched for articles relating to bariatric procedures and NAFLD.Pairwise meta-analysis was conducted to compare efficacy of bariatric procedures pre-vs.post-procedure with subgroup analysis to further compare restrictive against foregut bypass procedures.Results:Thirty-one articles involving 3,355 patients who underwent restrictive bariatric procedures(n=1,460)and foregut bypass(n=1,895)were included.Both foregut bypass(P<0.01)and restrictive procedures(P=0.03)significantly increased odds of fibrosis resolution.Compared to restrictive procedures,foregut bypass resulted in a borderline non-significant decrease in fibrosis score(P=0.06)and significantly lower steatosis score(P<0.001).For metabolic parameters,foregut bypass significantly lowered body mass index(P=0.003)and low-density lipoprotein(P=0.008)compared to restrictive procedures.No significant differences were observed between both procedures for aspartate aminotransferase(P=0.17)and alkaline phosphatase(P=0.61).However,foregut bypass resulted in significantly lower gamma-glutamyl transferase than restrictive procedures(P=0.01)while restrictive procedures resulted in significantly lower alanine transaminase than foregut bypass(P=0.02).Conclusions:The significant histological and metabolic advantages and comparable improvements in biochemical outcomes support the choice of foregut bypass over restrictive bariatric procedures in NAFLD management.
