Background and Aims:Nonalcoholic fatty liver disease(NAFLD)is commonly associated with obesity but can de-velop in normal-weight people(lean NAFLD).We compared outcomes in lean,overweight,and obese NAFLD.Methods:This ...Background and Aims:Nonalcoholic fatty liver disease(NAFLD)is commonly associated with obesity but can de-velop in normal-weight people(lean NAFLD).We compared outcomes in lean,overweight,and obese NAFLD.Methods:This retrospective chart review included patients at Stanford University Medical Center with NAFLD confirmed by imaging between March 1995 and December 2021.Lean,overweight,and obese patients had body mass index of<25.0,>25.0 and<29.9,and 230.0 kg/m2 for non-Asian and>23.0 and≥27.5 for overweight and obese Asian patients.Results:A total of 9061 lean(10.2%),overweight(31.7%),and obese(58.1%)patients were included.Lean patients were 5 years older than obese patients(53±17.4 VS.48.7±±15.1 years),more were female(59.6%vs.55.2%),white(49.1%vs.46.5%),had NASH(29.2%VS.22.5%),cirrhosis(25.3%.Vs.19.2%),or nonliver cancer(25.3%Vs.18.3%).Fewer had diabetes(21.7%Vs.35.8%)or metabolic comorbidi-ties(all p<0.0001).Lean NAFLD patients had liver-related mortality similar to other groups but higher overall(p=0.01)and nonliver-related(p=0.02)mortality.After multivariable model adjustment for covariates,differences between lean and obese NAFLD in liver-related,nonliver-related,and over-all mortality(adjusted hazard ratios of 1.34,1.00,and 1.32;p=0.66,0.99,and 0.20,respectively)were not significant.Conclusions:Lean NAFLD had fewer metabolic comorbidi-ties but similar adverse or worse outcomes,suggesting that it is not benign.Healthcare providers should provide the same level of care and intervention as for overweight and obese NAFLD.展开更多
Background and Aims:As practice patterns and hepatitis C virus(HCV)genotypes(GT)vary geographically,a global real-world study from both East and West covering all GTs can help inform practice policy toward the 2030 HC...Background and Aims:As practice patterns and hepatitis C virus(HCV)genotypes(GT)vary geographically,a global real-world study from both East and West covering all GTs can help inform practice policy toward the 2030 HCV elimination goal.This study aimed to assess the effectiveness and tolerability of DAA treatment in routine clinical practice in a multinational cohort for patients infected with all HCV GTs,focusing on GT3 and GT6.Methods:We analyzed the sustained virological response(SVR12)of 15,849 chronic hepatitis C patients from 39 Real-World Evidence from the Asia Liver Consortium for HCV clinical sites in Asia Pacific,North America,and Europe between 07/01/2014–07/01/2021.Results:The mean age was 62±13 years,with 49.6%male.The demographic breakdown was 91.1%Asian(52.9%Japanese,25.7%Chinese/Taiwan residents,5.4%Korean,3.3%Malaysian,and 2.9%Vietnamese),6.4%White,1.3%Hispanic/Latino,and 1%Black/African-American.Additionally,34.8%had cirrhosis,8.6%had hepatocellular carcinoma(HCC),and 24.9%were treatment-experienced(20.7%with interferon,4.3%with direct-acting antivirals).The largest group was GT1(10,246[64.6%]),followed by GT2(3,686[23.2%]),GT3(1,151[7.2%]),GT6(457[2.8%]),GT4(47[0.3%]),GT5(1[0.006%]),and untyped GTs(261[1.6%]).The overall SVR12 was 96.9%,with rates over 95%for GT1/2/3/6 but 91.5%for GT4.SVR12 for GT3 was 95.1%overall,98.2%for GT3a,and 94.0%for GT3b.SVR12 was 98.3%overall for GT6,lower for patients with cirrhosis and treatment-experienced(TE)(93.8%)but≥97.5%for tretment-naive patients regardless of cirrhosis status.On multivariable analysis,advanced age,prior treatment failure,cirrhosis,active HCC,and GT3/4 were independent predictors of lower SVR12,while being Asian was a significant predictor of achieving SVR12.Conclusions:In this diverse multinational realworld cohort of patients with various GTs,the overall cure rate was 96.9%,despite large numbers of patients with cirrhosis,HCC,TE,and GT3/6.SVR12 for GT3/6 with cirrhosis and TE was lower but still excellent(>91%).展开更多
文摘Background and Aims:Nonalcoholic fatty liver disease(NAFLD)is commonly associated with obesity but can de-velop in normal-weight people(lean NAFLD).We compared outcomes in lean,overweight,and obese NAFLD.Methods:This retrospective chart review included patients at Stanford University Medical Center with NAFLD confirmed by imaging between March 1995 and December 2021.Lean,overweight,and obese patients had body mass index of<25.0,>25.0 and<29.9,and 230.0 kg/m2 for non-Asian and>23.0 and≥27.5 for overweight and obese Asian patients.Results:A total of 9061 lean(10.2%),overweight(31.7%),and obese(58.1%)patients were included.Lean patients were 5 years older than obese patients(53±17.4 VS.48.7±±15.1 years),more were female(59.6%vs.55.2%),white(49.1%vs.46.5%),had NASH(29.2%VS.22.5%),cirrhosis(25.3%.Vs.19.2%),or nonliver cancer(25.3%Vs.18.3%).Fewer had diabetes(21.7%Vs.35.8%)or metabolic comorbidi-ties(all p<0.0001).Lean NAFLD patients had liver-related mortality similar to other groups but higher overall(p=0.01)and nonliver-related(p=0.02)mortality.After multivariable model adjustment for covariates,differences between lean and obese NAFLD in liver-related,nonliver-related,and over-all mortality(adjusted hazard ratios of 1.34,1.00,and 1.32;p=0.66,0.99,and 0.20,respectively)were not significant.Conclusions:Lean NAFLD had fewer metabolic comorbidi-ties but similar adverse or worse outcomes,suggesting that it is not benign.Healthcare providers should provide the same level of care and intervention as for overweight and obese NAFLD.
基金partially supported by an investigator-initiated research grant(IN-US-334-4309)from Gilead Sciences to Stanford University.
文摘Background and Aims:As practice patterns and hepatitis C virus(HCV)genotypes(GT)vary geographically,a global real-world study from both East and West covering all GTs can help inform practice policy toward the 2030 HCV elimination goal.This study aimed to assess the effectiveness and tolerability of DAA treatment in routine clinical practice in a multinational cohort for patients infected with all HCV GTs,focusing on GT3 and GT6.Methods:We analyzed the sustained virological response(SVR12)of 15,849 chronic hepatitis C patients from 39 Real-World Evidence from the Asia Liver Consortium for HCV clinical sites in Asia Pacific,North America,and Europe between 07/01/2014–07/01/2021.Results:The mean age was 62±13 years,with 49.6%male.The demographic breakdown was 91.1%Asian(52.9%Japanese,25.7%Chinese/Taiwan residents,5.4%Korean,3.3%Malaysian,and 2.9%Vietnamese),6.4%White,1.3%Hispanic/Latino,and 1%Black/African-American.Additionally,34.8%had cirrhosis,8.6%had hepatocellular carcinoma(HCC),and 24.9%were treatment-experienced(20.7%with interferon,4.3%with direct-acting antivirals).The largest group was GT1(10,246[64.6%]),followed by GT2(3,686[23.2%]),GT3(1,151[7.2%]),GT6(457[2.8%]),GT4(47[0.3%]),GT5(1[0.006%]),and untyped GTs(261[1.6%]).The overall SVR12 was 96.9%,with rates over 95%for GT1/2/3/6 but 91.5%for GT4.SVR12 for GT3 was 95.1%overall,98.2%for GT3a,and 94.0%for GT3b.SVR12 was 98.3%overall for GT6,lower for patients with cirrhosis and treatment-experienced(TE)(93.8%)but≥97.5%for tretment-naive patients regardless of cirrhosis status.On multivariable analysis,advanced age,prior treatment failure,cirrhosis,active HCC,and GT3/4 were independent predictors of lower SVR12,while being Asian was a significant predictor of achieving SVR12.Conclusions:In this diverse multinational realworld cohort of patients with various GTs,the overall cure rate was 96.9%,despite large numbers of patients with cirrhosis,HCC,TE,and GT3/6.SVR12 for GT3/6 with cirrhosis and TE was lower but still excellent(>91%).
