LINKED CONTENT
This article is linked to Wijarnpreecha et al papers. To view these articles, visit https://doi.org/10.1111/apt.16590 and https://doi.org/10.1111/apt.16293
Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in the world. NAFLD is a hepatic manifestation of insulin resistance, the core pathophysiology of diabetes. ...Multiple clinical studies show that diabetes increases the risk of liver disease progression and cirrhosis development in patients with NAFLD. Diabetes has causal associations with many different cancers, including hepatocellular carcinoma (HCC). More recent studies demonstrate that diabetes increases the risk of HCC in patients with underlying NAFLD cirrhosis, confirming the direct hepatocarcinogenic effect of diabetes among cirrhosis patients. Diabetes promotes hepatocarcinogenesis via the activation of inflammatory cascades producing reactive oxygen species and proinflammatory cytokines, leading to genomic instability, cellular proliferation, and inhibition of apoptosis. Given the global increase in the burden of NAFLD and HCC, high-risk patients such as older diabetic individuals should be carefully monitored for HCC development. Future larger studies should explore whether the effect of diabetes on HCC risk in NAFLD cirrhosis is modifiable by the type of antidiabetic medication and the effectiveness of diabetes control.
Background and Aims
Real‐world data for treatment effectiveness and renal outcomes in chronic hepatitis B (CHB) patients who were switched to the new and safer prodrug tenofovir alafenamide (TAF) ...from tenofovir disoproxil fumarate (TDF) are limited. Therefore, we aimed to evaluate treatment and renal outcomes of this population.
Approach and Results
We analyzed 834 patients with CHB previously treated with TDF for ≥12 months who were switched to TAF in routine practice at 13 US and Asian centers for changes in viral (HBV DNA < 20 IU/mL), biochemical (alanine aminotransferase ALT < 35/25 U/L for male/female), and complete (viral+biochemical) responses, as well as estimated glomerular filtration rate (eGFR; milliliters per minute per 1.73 square meters) up to 96 weeks after switch. Viral suppression (P < 0.001) and ALT normalization (P = 0.003) rates increased significantly after switch, with a trend for increasing complete response (Ptrend = 0.004), while the eGFR trend (Ptrend > 0.44) or mean eGFR (P > 0.83, adjusted for age, sex, baseline eGFR, and diabetes, hypertension, or cirrhosis by generalized linear modeling) remained stable. However, among those with baseline eGFR < 90 (chronic kidney disease CKD stage ≥2), mean eGFR decreased significantly while on TDF (P = 0.029) but not after TAF switch (P = 0.90). By week 96, 21% (55/267) of patients with CKD stage 2 at switch improved to stage 1 and 35% (30/85) of CKD stage 3‐5 patients improved to stage 2 and 1.2% (1/85) to stage 1.
Conclusions
Overall, we observed continued improvement in virologic response, ALT normalization, and no significant changes in eGFR following switch to TAF from TDF.
Nonalcoholic fatty liver disease (NAFLD) is traditionally associated with obesity. However, there is a subtype of NAFLD, namely NAFLD in lean, that occurs without obesity. However, a recent call to ...redefine NAFLD to metabolic-associated fatty liver disease focuses on obesity and metabolic dysfunction. Criticism has arisen from the perceived over emphasis on systemic comorbidities, which may disadvantage the lean. The current analysis seeks to quantify the degree of metabolic dysfunction in NAFLD in lean and compare with NAFLD in overweight and obese and non-NAFLD.
Medline and Embase databases were searched from inception to March 3, 2022. The inclusion criteria were articles with NAFLD in lean patients presenting with baseline metabolic parameters. Comparisons were conducted with subgroup analysis.
Eighty-five articles were included in the meta-analysis. NAFLD in lean accounted for 13.11% (95% confidence interval CI, 10.26%-16.62%) of the global population and 14.55% (95% CI, 11.32%-18.51%) in Asia. The degree of metabolic dysfunction was weight dependent with significantly less metabolic dysfunction in NAFLD in lean subjects as compared with NAFLD in overweight counterparts. For NAFLD in lean, only 19.56% (95% CI, 15.28%-24.69%) of the subjects were diabetic, whereas 45.70% (95% CI, 35.01%-56.80%) of obese subjects with NAFLD had diabetes (P < .01). Fasting blood glucose and systolic and diastolic blood pressure values were significantly lower in subjects with NAFLD in lean than in overweight and obese.
The current analysis highlights the weight-dependent nature of metabolic dysfunction in NAFLD. Lean subjects with NAFLD were significantly less metabolically unhealthy than were obese and overweight persons with NAFLD. An overreliance on metabolic dysfunction in defining fatty liver will be a flaw in potentially excluding previously characterized NAFLD.
the objective of this study was to explore whether race-based difference in fall risk may be mediated by environmental and physical performance risk factors.
using data from a nationally ...representative longitudinal survey of 7,609 community-dwelling participants in the National Health and Aging Trends Study (NHATS), we evaluated whether racial differences in fall risk may be explained by physical performance level (measured by the Short Physical Performance Battery), mobility disability, physical activity level and likelihood of living alone. Multivariate Poisson regression and mediation models were used in analyses.
in whites and blacks, the annual incidence of 'any fall' was 33.8 and 27.1%, respectively, and the annual incidence of 'recurrent falls' was 15.5 and 12.3%, respectively. Compared with whites, blacks had relative risks of 0.7 (95% confidence interval 0.6-0.8) and 0.6 (0.5-0.8) for sustaining any fall and recurrent falls, respectively, in adjusted analyses. Blacks had poorer performance on the SPPB (P < 0.001), higher levels of mobility disability (P < 0.001), similar levels of physical activity (P = 0.19) and were equally likely to live alone relative to whites (P = 0.77). Mediation analysis revealed that these risk factors collectively acted as suppressors and none of these factors accounted for the racial differences in fall risk observed.
relative to whites, blacks were at 30 and 40% decreased risk of sustaining any fall and recurrent falls, respectively. This difference in risk remains unexplained.
Although oral antiviral therapy (OAV) is reported to improve outcomes in patients with hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC), it is underutilized. We determined the rate and ...factors associated with OAV utilization among patients with HBV-related HCC in a US population with health insurance.
Patients with HBV-related HCC were identified from the de-identified administrative health claims database for patients with private insurance, Optum Clinformatics (2003-2021).
We identified 2129 patients with HBV-related HCC: 71% male, mean age 62.7 ± 12.5 years, 40% Asian individuals, 72% with cirrhosis, and 37% received OAV. The treatment rate improved over time (40.5% after 2010 vs 26.3% earlier; P < .001). Significantly lower treatment rates were noted for females, non-Asian patients, noncirrhotic patients, and patients without gastroenterologist/hepatologist or infectious disease (GI/ID) specialist care (P < .0001). OAV treatment predictors included Asian race and ethnicity (adjusted odds ratio aOR, 3.6; 95% CI, 2.8-4.5; P < .001), male sex (aOR, 1.6; 95% CI, 1.3-2.0; P < .001), seeing a GI/ID specialist (aOR, 1.5; 95% CI, 1.10-1.99; P = .0091), having compensated cirrhosis (aOR, 2.2; 95% CI, 1.7-2.8; P < .001), and being treated from 2011 to 2021 (aOR, 2.3; 95% CI, 1.8-3.0; P < .001); being younger (aOR, 0.98; 95% CI, 0.98-0.99; P < .001) was less likely for treatment. OAV initiated at or before HCC diagnosis was associated independently with improved survival (adjusted hazard ratio, 0.84; 95% CI, 0.72-0.99; P = .037).
Among patients with HBV-related HCC, only 1 in 3 received OAV despite having insurance coverage. Efforts must continue to develop ways to improve HBV OAV treatment, especially among females, non-Asian patients, and patients without cirrhosis or not seen by specialists.
Abstract
We introduce the New-ANGELS program, an XMM-Newton survey of a ∼7.2 deg
2
area around M31, which aims to study the X-ray populations in the M31 disk and the X-ray-emitting hot gas in the ...inner halo of M31 up to 30 kpc. In this first paper, we report the catalog of 4506 detected X-ray sources and attempt to cross-identify or roughly classify them. We identify 352 single stars in the foreground, 35 globular clusters, and 27 supernova remnants associated with M31, as well as 62 active galactic nuclei, 59 galaxies, and one galaxy cluster in the background. We uniquely classify 236 foreground stars and 17 supersoft sources based on their X-ray colors. X-ray binaries (83 low-mass and one high-mass) are classified based on their X-ray colors and X-ray variabilities. The remaining X-ray sources either have too low signal-to-noise ratios to calculate their X-ray colors or do not have a unique classification, so are regarded as unclassified. The X-ray source catalog is published online. Studies of the X-ray source populations and the contribution of X-ray sources in the unresolved X-ray emissions based on this catalog will be published in companion papers.
LINKED CONTENT
This article is linked to Wijarnpreecha et al papers. To view these articles, visit https://doi.org/10.1111/apt.17424 and https://doi.org/10.1111/apt.17453
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