With its increasing incidence, nonalcoholic fatty liver disease (NAFLD) is of particular concern in the Veterans Health Administration (VHA).
Dr Patel and colleagues evaluated risk factors for advanced fibrosis in biopsy-proven NAFLD in the VHA, to identify patients at risk for adverse outcomes.
In randomly selected cases from VHA databases (2005-2015), the team performed a retrospective case-control study in adults with biopsy-defined NAFLD or normal liver.
Of 2091 patients reviewed, the team identified 399 that met inclusion criteria.
Normal controls had normal liver function.
The four NAFLD cohorts included: NAFL steatosis, nonalcoholic steatohepatitis (NASH) without fibrosis, NAFLD/NASH stage 1-3 fibrosis, and NAFLD/NASH cirrhosis.
|12% to 20% were enrolled in diet/exercise programs|
|Alimentary Pharmacology & Therapeutics|
The researchers separately identified NAFLD with hepatocellular carcinoma (HCC).
The team observed that NAFLD patients with any fibrosis were on average severely obese.
The researchers found that diabetes and hypertension were more common in NAFLD with fibrosis or HCC.
Across NAFLD, 12% to 20% were enrolled in diet/exercise programs, and 0%-3% had bariatric surgery.
The team noted that Hispanics exhibited higher rates of NASH, while Blacks had low NAFLD rates, particularly NAFLD cirrhosis and HCC.
Diabetes and BMI were the most significant predictors of advanced fibrosis.
Dr Patel's team comments, "In the VHA, diabetes and severe obesity increased risk for advanced fibrosis in NAFLD."
"Of these patients, only a small proportion had enrolled in diet/exercise programs or had bariatric surgery."
"These results suggest that providers should focus/tailor interventions to improve outcomes, particularly in those with diabetes and severe obesity."