- Email: [email protected]
Su1050 Hyperhomocysteinemia in Non-Cirrhotic, Insulin Resistant and Obese Patients With Non-Alcoholic Fatty Liver Disease
subjects with fatty liver increased gradually in both men (23.9% vs. 33.2% vs. 45.3%) and women (24.8% vs. 34.2% vs. 35.6%), but the prevalence of impaired fasting glucose in subjects with fatty liver did not change significantly in men (21.7% vs. 27.0% vs. 29.7%) or women (21.7% vs. 17.6% vs. 19.9%). FIB4 index in subjects with fatty liver was significantly higher in 2012 than in 2002 among men in the 30- to 39-year, 40- to 49-year and 50- to 59-year age groups and among women in the 50- to 59-year and 60- to 69-year age groups. CONCLUSION: Nonobese individuals account for approximately half of Japanese patients with fatty liver. The prevalence of hypertension in subjects with fatty liver has increased over time. Progressive liver fibrosis may increase in subjects with fatty liver.
0.79; p for interaction = 0.07) and those with insulin resistance (OR = 0.22, 95% CI 0.05 - 0.95; p for interaction = 0.24). However, no significant associations were found between PPIs or H1RA use and prevalent NAFLD. Conclusion: These findings, from the first human study to investigate an association of PPIs or H1RA/H2RA use with NAFLD, suggest that H2RA use may be associated with a lower prevalence of NAFLD, primarily among men and patients with insulin resistance. However, prospective studies and randomized, controlled clinical trials are needed to assess whether H2RA use can prevent the incidence or reduce the progression of NAFLD, and if so, whether such effect(s) may be limited to those in certain population subgroups.
Su1050
AASLD Abstracts
Hyperhomocysteinemia in Non-Cirrhotic, Insulin Resistant and Obese Patients With Non-Alcoholic Fatty Liver Disease Nikhil Patel, Sulabhsinh Solanki, Payal Patel, Sanjay Patel, Chetan Lakhani, Deepak Amarapurkar Background: Insulin resistance(IR) and obesity(O) predispose to non-alcoholic fatty liver disease(NAFLD) and metabolic syndrome(MS). These are increasingly recognized with epidemic of obesity and diabetes in India. Recently, hyperhomocysteinemia (HHcy) is recognized to be commonly present in NAFLD adults and might affect course of NAFLD. This study was planned to identify prevalence and importance of HHcy in development of NAFLD in IR-O subjects. Methods: This observational prospective study was planned on consecutive IR-O children (identified in school health check-up, n=78, age=11.4±2.9, males=57(73%)) and adults (attending tertiary-care hospital, n=100, age=39.6±11.8, males=67 (67%)). All underwent anthropometry, blood-pressure measurement, blood sugar, lipids, insulin, liver profile, ultrasonography, homocysteine and tests to rule out viral, metabolic and autoimmune liver disease. Results: Presence of NAFLD (71.7% vs. 79%) or non-alcoholic steatohepatitis(NASH)(44.8% vs. 54%) was similar, but HHcy(28.2% vs. 66%) and MS (19.2% vs 68%) were significantly more in adults than children. In subgroup analysis, in IR-O NAFLD, HHcy was associated with less NASH in both children [5/21(23.8%) vs. 30/35(85.7%)] and adults [29/52(48%) vs. 25/27(92.5%)]. In IR-O children, NAFLD was more in HHcy [21/22(95.4%) vs. 35/56(62.5%)] than in MS [9/15(60%) vs. 47/63(74.6%)]. In IR-O adults, NAFLD was more in MS [58/68(85.2%) vs. 21/32(65.6%)] than in HHcy [(52/66(78.7%) vs. 27/ 34(79.4%)] Conclusions: HHcy is important factor in development of NAFLD and NASH in IR-obese patients especially in children. Su1051 Prevalence, Risk Factors and Associations of Childhood Obesity in Western India Nikhil Patel, Sulabhsinh Solanki, Payal Patel, Chetan Lakhani, Sanjay Patel, Deepak Amarapurkar Background: In India, prevalence of childhood obesity is around 5%, but data on prevalence of metabolic syndrome(MS) and non-alcoholic fatty liver disease(NAFLD) is sparse. This prospective observational study was planned to study obesity prevalence and risk factors in school children. Methods: This study was planned on consecutive school children being evaluated during health screening programme. All students underwent history (including activity, diet and health awareness), examination (including blood pressure, BMI and anthropometry), blood sugar, lipid, liver function tests, homocysteine and sonography. Statistics performed using chi square test. Results: 3616 students(age=10.1±6.9 years, range=5-15 years, males=2229) were divided in three groups: group-1= overweight/obese(n=280(7.7%), age=11.6±5.2, male=177); group-2= normal weight(n=1967(54.3%), age=10.2±6.2, male= 1138); group-3= underweight (n=1369(37.8%), age=9.7±5.7, male=909). On comparing these groups respectively, significant parameters in group-1 were: hypertension [34(12.1%) vs. 68(3.4%) vs. 45(3.2%)], hyperlipidemia [80(28.5%) vs. 26(1. 3%) vs. 10( 0.7%)], hyperhomocysteinemia [47(16.7%) vs. 96(4.8%) vs. 13(0.9%)], non-alcoholic fatty liver disease[81(28.9%) vs. 56(2.8% ) vs. 29(2.1%)], non-alcoholic steatohepatitis[42(15%) vs. 29(1.4% ) vs. 22(1.6%)],family history for metabolic syndrome diseases [132(47.1%) vs. 561(28.5%) vs. 215(15.7%)], fast food consumption [264(94.2%) vs. 1772(90%) vs. 1195(87.2%)], lack of aerobic/static exercise [233(83.2%) vs. 455(23.1%) vs. 348(25.4%)], lack of outdoor activity [190(67.8%) vs. 1032(52.4%) vs. 80(5.8%)]. Only 422/3616(11.6%) students (and their parents) regarded obesity as disease. Conclusion: Overweight/obese students were predisposed to NAFLD and metabolic syndrome. Major factors leading to obesity were fast food consumption and sedentary life-style. There is need for educating students and parents regarding obesity.
Su1053 Large and Statistically Significant Differences in Incidence of Metabolic Syndrome and Outcomes of Stemi Among 3,107 Patients With NASH Versus Controls Without NASH Nisha H. Sharma, Rahul Sao, Dhruv Mehta, Mitchell S. Cappell
Su1052
Background - Non-alcoholic steatohepatitis (NASH) is associated with metabolic syndrome and risk factors for coronary artery disease. Scant data exist on prevalence and outcomes of STEMI (ST segment elevation myocardial infarction) in patients with NASH. Methods All adult (age≥18 years) STEMI patients treated with percutaneous intervention (PCI) with a concurrent diagnosis of NASH were identified from the National Inpatient Sample (NIS) database of the Healthcare Cost and Utilization Project (HCUP) for years 2003-2011 using the International Classification of Diseases, Ninth Revision (ICD-9) codes. Baseline demographics, clinical characteristics, comorbidities, and outcomes were retrospectively analyzed for these patients and compared with controls (patients with STEMI without a diagnosis of NASH). Results - Of 2,210,724 STEMI patients who underwent PCI, 3,107 (0.1%) had an accompanying diagnosis of NASH. Patients with NASH compared to controls were significantly younger (58.3 ± 13.0 vs. 65.05 years, p<0.001); significantly less frequently female (31.3% vs. 35.5%, p<0.001; OR=0.83); and significantly less frequently white (76.3% vs. 79.2%, p<0.001; OR= 0.84). Patients with NASH more frequently had diabetes (45.5% vs. 26.5%, OR=7.31; p<0.001), hypertension (67.1% vs. 56.6%, OR=1.56; p<0.001), dyslipidemia (54.0% vs. 37.2%, OR=1.98; p<0.001), and obesity (34.0% vs. 8.8%, OR=5.35; p<0.001). Thrombocytopenia was significantly more common in patients with NASH. The incidence of gastrointestinal bleeding was similar in both groups (rate=2.8% for both groups). Patients with NASH had more frequent platelet and fresh frozen plasma transfusions, but had similar frequencies of
H2-Receptor Antagonists Use Is Associated With Lower Prevalence of Nonalcoholic Fatty Liver Disease: A Population-Based Study From the National Health and Nutrition Examination Survey, 2001-2006 Huafeng Shen, Suthat Liangpunsakul, Ghulamullah Shahzad, Paul Mustacchia Background & Aim: Recent basic mechanistic studies found that proton pump inhibitors (PPIs) or histamine antagonists inhibited multiple pathways involved in non-alcoholic fatty liver disease (NAFLD) development. The aim of this study was to investigate an association between PPIs or H1/H2-receptor antagonists (H1RA/H2RA) use and NAFLD prevalence in the general US population. Methods: We conducted a cross-sectional analysis of data from the National Health and Nutrition Examination Survey, 2001 - 2006. We included 10,398 adults aged 20 - 74 years who had alanine aminotransferase (ALT) data; of those, 2,058 were identified as having NAFLD and 8,340 as controls. NAFLD was defined as elevated serum aminotransferases without any indication of other causes of chronic liver disease. PPIs or H1RA/H2RA use was defined as use of prescription medications in the preceding month. Results: In the multivariate unconditional logistic regression analysis, H2RA use was inversely associated with prevalent NAFLD (odds ratio [OR] = 0.43, 95% confidence interval [CI] 0.18 - 0.99), a finding that was primarily limited to men (OR = 0.18, 95% CI 0.04 -
AASLD Abstracts
S-1050
0.79; p for interaction = 0.07) and those with insulin resistance (OR = 0.22, 95% CI 0.05 - 0.95; p for interaction = 0.24). However, no significant associations were found between PPIs or H1RA use and prevalent NAFLD. Conclusion: These findings, from the first human study to investigate an association of PPIs or H1RA/H2RA use with NAFLD, suggest that H2RA use may be associated with a lower prevalence of NAFLD, primarily among men and patients with insulin resistance. However, prospective studies and randomized, controlled clinical trials are needed to assess whether H2RA use can prevent the incidence or reduce the progression of NAFLD, and if so, whether such effect(s) may be limited to those in certain population subgroups.
Su1050
AASLD Abstracts
Hyperhomocysteinemia in Non-Cirrhotic, Insulin Resistant and Obese Patients With Non-Alcoholic Fatty Liver Disease Nikhil Patel, Sulabhsinh Solanki, Payal Patel, Sanjay Patel, Chetan Lakhani, Deepak Amarapurkar Background: Insulin resistance(IR) and obesity(O) predispose to non-alcoholic fatty liver disease(NAFLD) and metabolic syndrome(MS). These are increasingly recognized with epidemic of obesity and diabetes in India. Recently, hyperhomocysteinemia (HHcy) is recognized to be commonly present in NAFLD adults and might affect course of NAFLD. This study was planned to identify prevalence and importance of HHcy in development of NAFLD in IR-O subjects. Methods: This observational prospective study was planned on consecutive IR-O children (identified in school health check-up, n=78, age=11.4±2.9, males=57(73%)) and adults (attending tertiary-care hospital, n=100, age=39.6±11.8, males=67 (67%)). All underwent anthropometry, blood-pressure measurement, blood sugar, lipids, insulin, liver profile, ultrasonography, homocysteine and tests to rule out viral, metabolic and autoimmune liver disease. Results: Presence of NAFLD (71.7% vs. 79%) or non-alcoholic steatohepatitis(NASH)(44.8% vs. 54%) was similar, but HHcy(28.2% vs. 66%) and MS (19.2% vs 68%) were significantly more in adults than children. In subgroup analysis, in IR-O NAFLD, HHcy was associated with less NASH in both children [5/21(23.8%) vs. 30/35(85.7%)] and adults [29/52(48%) vs. 25/27(92.5%)]. In IR-O children, NAFLD was more in HHcy [21/22(95.4%) vs. 35/56(62.5%)] than in MS [9/15(60%) vs. 47/63(74.6%)]. In IR-O adults, NAFLD was more in MS [58/68(85.2%) vs. 21/32(65.6%)] than in HHcy [(52/66(78.7%) vs. 27/ 34(79.4%)] Conclusions: HHcy is important factor in development of NAFLD and NASH in IR-obese patients especially in children. Su1051 Prevalence, Risk Factors and Associations of Childhood Obesity in Western India Nikhil Patel, Sulabhsinh Solanki, Payal Patel, Chetan Lakhani, Sanjay Patel, Deepak Amarapurkar Background: In India, prevalence of childhood obesity is around 5%, but data on prevalence of metabolic syndrome(MS) and non-alcoholic fatty liver disease(NAFLD) is sparse. This prospective observational study was planned to study obesity prevalence and risk factors in school children. Methods: This study was planned on consecutive school children being evaluated during health screening programme. All students underwent history (including activity, diet and health awareness), examination (including blood pressure, BMI and anthropometry), blood sugar, lipid, liver function tests, homocysteine and sonography. Statistics performed using chi square test. Results: 3616 students(age=10.1±6.9 years, range=5-15 years, males=2229) were divided in three groups: group-1= overweight/obese(n=280(7.7%), age=11.6±5.2, male=177); group-2= normal weight(n=1967(54.3%), age=10.2±6.2, male= 1138); group-3= underweight (n=1369(37.8%), age=9.7±5.7, male=909). On comparing these groups respectively, significant parameters in group-1 were: hypertension [34(12.1%) vs. 68(3.4%) vs. 45(3.2%)], hyperlipidemia [80(28.5%) vs. 26(1. 3%) vs. 10( 0.7%)], hyperhomocysteinemia [47(16.7%) vs. 96(4.8%) vs. 13(0.9%)], non-alcoholic fatty liver disease[81(28.9%) vs. 56(2.8% ) vs. 29(2.1%)], non-alcoholic steatohepatitis[42(15%) vs. 29(1.4% ) vs. 22(1.6%)],family history for metabolic syndrome diseases [132(47.1%) vs. 561(28.5%) vs. 215(15.7%)], fast food consumption [264(94.2%) vs. 1772(90%) vs. 1195(87.2%)], lack of aerobic/static exercise [233(83.2%) vs. 455(23.1%) vs. 348(25.4%)], lack of outdoor activity [190(67.8%) vs. 1032(52.4%) vs. 80(5.8%)]. Only 422/3616(11.6%) students (and their parents) regarded obesity as disease. Conclusion: Overweight/obese students were predisposed to NAFLD and metabolic syndrome. Major factors leading to obesity were fast food consumption and sedentary life-style. There is need for educating students and parents regarding obesity.
Su1053 Large and Statistically Significant Differences in Incidence of Metabolic Syndrome and Outcomes of Stemi Among 3,107 Patients With NASH Versus Controls Without NASH Nisha H. Sharma, Rahul Sao, Dhruv Mehta, Mitchell S. Cappell
Su1052
Background - Non-alcoholic steatohepatitis (NASH) is associated with metabolic syndrome and risk factors for coronary artery disease. Scant data exist on prevalence and outcomes of STEMI (ST segment elevation myocardial infarction) in patients with NASH. Methods All adult (age≥18 years) STEMI patients treated with percutaneous intervention (PCI) with a concurrent diagnosis of NASH were identified from the National Inpatient Sample (NIS) database of the Healthcare Cost and Utilization Project (HCUP) for years 2003-2011 using the International Classification of Diseases, Ninth Revision (ICD-9) codes. Baseline demographics, clinical characteristics, comorbidities, and outcomes were retrospectively analyzed for these patients and compared with controls (patients with STEMI without a diagnosis of NASH). Results - Of 2,210,724 STEMI patients who underwent PCI, 3,107 (0.1%) had an accompanying diagnosis of NASH. Patients with NASH compared to controls were significantly younger (58.3 ± 13.0 vs. 65.05 years, p<0.001); significantly less frequently female (31.3% vs. 35.5%, p<0.001; OR=0.83); and significantly less frequently white (76.3% vs. 79.2%, p<0.001; OR= 0.84). Patients with NASH more frequently had diabetes (45.5% vs. 26.5%, OR=7.31; p<0.001), hypertension (67.1% vs. 56.6%, OR=1.56; p<0.001), dyslipidemia (54.0% vs. 37.2%, OR=1.98; p<0.001), and obesity (34.0% vs. 8.8%, OR=5.35; p<0.001). Thrombocytopenia was significantly more common in patients with NASH. The incidence of gastrointestinal bleeding was similar in both groups (rate=2.8% for both groups). Patients with NASH had more frequent platelet and fresh frozen plasma transfusions, but had similar frequencies of
H2-Receptor Antagonists Use Is Associated With Lower Prevalence of Nonalcoholic Fatty Liver Disease: A Population-Based Study From the National Health and Nutrition Examination Survey, 2001-2006 Huafeng Shen, Suthat Liangpunsakul, Ghulamullah Shahzad, Paul Mustacchia Background & Aim: Recent basic mechanistic studies found that proton pump inhibitors (PPIs) or histamine antagonists inhibited multiple pathways involved in non-alcoholic fatty liver disease (NAFLD) development. The aim of this study was to investigate an association between PPIs or H1/H2-receptor antagonists (H1RA/H2RA) use and NAFLD prevalence in the general US population. Methods: We conducted a cross-sectional analysis of data from the National Health and Nutrition Examination Survey, 2001 - 2006. We included 10,398 adults aged 20 - 74 years who had alanine aminotransferase (ALT) data; of those, 2,058 were identified as having NAFLD and 8,340 as controls. NAFLD was defined as elevated serum aminotransferases without any indication of other causes of chronic liver disease. PPIs or H1RA/H2RA use was defined as use of prescription medications in the preceding month. Results: In the multivariate unconditional logistic regression analysis, H2RA use was inversely associated with prevalent NAFLD (odds ratio [OR] = 0.43, 95% confidence interval [CI] 0.18 - 0.99), a finding that was primarily limited to men (OR = 0.18, 95% CI 0.04 -
AASLD Abstracts
S-1050