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

• Published in: Alimentary pharmacology & therapeutics Vol. 47; no. 2; pp. 268 - 278
• Main Authors: Patel, Y. A., Gifford, E. J., Glass, L. M., McNeil, R., Turner, M. J., Han, B., Provenzale, D., Choi, S. S., Moylan, C. A., Hunt, C. M.
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01-01-2018
• Subjects: Adult; Aged; Biopsy; Biopsy - methods; Body mass; Carcinoma, Hepatocellular - complications; Carcinoma, Hepatocellular - epidemiology; Case-Control Studies; Cirrhosis; Diabetes; Diabetes mellitus; Disease Progression; Fatty liver; Female; Fibrosis; Gastrointestinal surgery; Health risks; Hepatocellular carcinoma; Humans; Liver; Liver cirrhosis; Liver Cirrhosis - epidemiology; Liver Cirrhosis - etiology; Liver Cirrhosis - pathology; Liver diseases; Liver Neoplasms - complications; Liver Neoplasms - epidemiology; Male; Middle Aged; Non-alcoholic Fatty Liver Disease - complications; Non-alcoholic Fatty Liver Disease - epidemiology; Non-alcoholic Fatty Liver Disease - pathology; Obesity; Retrospective Studies; Risk Factors; Severity of Illness Index; Steatosis; Surgery; United States - epidemiology; United States Department of Veterans Affairs; Veterans - statistics & numerical data; Veterans Health
• ISSN: 0269-2813; 1365-2036
• DOI: 10.1111/apt.14411

Summary
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.
Linked ContentThis article is linked to Leey and Cusi and Patel and Hunt papers. To view these articles visit https://doi.org/10.1111/apt.14473 and https://doi.org/10.1111/apt.14505.