PREVALENCE AND PREDICTORS OF NONALCOHOLIC FATTY LIVER DISEASE (NAFLD) IN VETERANS

退伍军人中非酒精性脂肪肝 (NAFLD) 的患病率和预测因素

• 批准号: 10038804
• 负责人: Hashem B El-Serag
• 金额: --
• 依托单位: MICHAEL E DEBAKEY VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-10-01 至 2022-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10038804
• 关键词: Acids; Address; Adult; Affect; Age; Alcohols; Algorithms; Biochemical; Biological Markers; Blood Tests; Blood specimen; Body Weight decreased; Body fat; Body mass index; Calibration; Caring; Cirrhosis; Clinic; Clinical; Clinical Pathways; Clinical Practice Guideline; Clinical Trials; Complication; Cross-Sectional Studies; Cytokeratin-18 Staining Method; Data; Data Set; Detection; Diabetes Mellitus; Diagnosis; Dietitian; Discrimination; Disease; Disease stratification; Enrollment; Ethnic Origin; Exercise; Family; Fatty Liver; Fatty acid glycerol esters; Female; Fibrosis; Gender; Genetic; Healthcare; Healthcare Systems; Hepatic; Histologic; ITGB2 gene; Incidence; Inflammation; Insulin Resistance; Intervention; Life Style; Literature; Liver; Liver Failure; Liver Fibrosis; Liver Function Tests; Liver diseases; Magnetic Resonance Imaging; Measures; Medical; Medical History; Medical center; Metabolic; Metabolic syndrome; Obesity; Patients; Pharmaceutical Preparations; Policies; Population; Predictive Factor; Prevalence; Prevention; Primary Health Care; Primary carcinoma of the liver cells; Probability; Prognosis; Progressive Disease; Protons; Questionnaires; Race; Recording of previous events; Research; Resource Allocation; Resources; Risk; Risk Factors; Sampling; Serology; Services; Severities; Severity of illness; Smoking; Staging; Testing; Time; United States Department of Veterans Affairs; Veterans; Veterans Health Administration; base; cancer transplantation; chronic liver disease; clinical care; clinical practice; cohort; cost; database design; density; disorder risk; elastography; health care settings; high risk; improved; liver biopsy; liver transplantation; male; military veteran; non-alcoholic fatty liver disease; nonalcoholic steatohepatitis; novel; obese person; predictive modeling; primary care setting; screening; serological marker; sex; study population; waist circumference

The objective of this application is to determine the burden of non-alcoholic fatty liver disease (NAFLD) among patients receiving primary care at the Department of Veterans Affairs (VA) health care system. NAFLD affects an estimated 20%-30% of the adult non-VA US population and is projected to become the main cause of end- stage liver disease in the next 10 years. NAFLD encompasses a histologic spectrum ranging from simple steatosis to non-alcoholic steatohepatitis (NASH). Around 20% of patients with NASH undergo fibrotic progression to cirrhosis, which increases risk of liver failure the risk of hepatocellular carcinoma. NAFLD is considered the hepatic complication of obesity and insulin resistance. Proper diagnosis of NAFLD and subsequent treatment (e.g., dietitian services) is associated with improved biochemical and histological features of NAFLD. There are also ongoing clinical trials with promising medications (e.g., obeticholic acid) for NASH. Given the veteran population is disproportionately affected by the main risk factors for NAFLD (e.g., diabetes, obesity), our central hypothesis is that the veteran population in primary care is particularly susceptible to a high burden from NAFLD. It is unclear whether the VA is currently equipped to deal with this costly disorder given the lack of basic information on the prevalence, determinants, and clinical recognition of NAFLD in the VA. Advances in magnetic resonance imaging (MRI) has revolutionized the diagnosis and severity staging of NAFLD, thus obviating the need for liver biopsy in most cases. However, the use of MRI for NAFLD screening in a primary care setting is impractical and expensive. There are no agreed upon clinical prediction rules, and none that is tested in VA settings. We will address our hypothesis by conducting a probability-based cross-sectional study of 1000 veterans (500 males and 500 females) enrolled in the VA for their primary healthcare. Specific Aim #1: To determine the overall and race- and sex- specific prevalence of NAFLD (and Advanced Hepatic Fibrosis) using highly sensitive and specific MRI criteria in a large and representative sample of veterans enrolled at the Michael E. DeBakey VA Medical Center in Houston for their primary healthcare. This aim will be accomplished by combined use of liver magnetic resonance imaging proton density fat fraction (MRI-PDFF) and elastography (MRE). Specific Aim #2: To evaluate the association between presence and severity of NAFLD and potential risk factors, including demographic (gender, race/ethnicity), anthropometric (BMI, waist circumference, and body fat by bioimpedance analysis), clinical (medical history, family history, and medications), serologic (CD18), genetic (PNPLA3), biochemical (LFTs, serologic biomarkers of hepatic fibrosis and steatosis), metabolic (serologic markers of metabolic syndrome), and lifestyle (smoking, alcohol, exercise) factors. Specific Aim #3: Use the information on risk factors and biomarkers to construct and validate an algorithm that can be used at the primary care level to identify patients at high risk of NAFLD and NASH for further referral. The information on prevalence in different groups are essential for effective VA healthcare planning and resource allocation. The study will aid in the clinical recognition of NAFLD in the VA primary care setting using VA specific risk factors. Finally, our study will provide data needed to support future research to develop clinical pathways for detection and referral.

该应用的目的是确定非酒精性脂肪肝疾病（NAFLD）的负担 在退伍军人事务部（VA）医疗保健系统接受初级保健的患者。 NAFLD会影响 估计有20％-30％的美国非VA美国人口，预计将成为最终的主要原因 未来10年的肝病。 NAFLD包括一个组织学频谱，从简单 脂肪变性到非酒精性脂肪性肝炎（NASH）。大约20％的NASH患者患有纤维化 向肝硬化的进展，增加了肝衰竭的风险肝细胞癌的风险。 nafld是 被认为是肥胖和胰岛素抵抗的肝并发症。适当诊断NAFLD和 随后的治疗（例如，营养师服务）与改善的生化和组织学有关 NAFLD的功能。还进行了正在进行的临床试验，并进行了有前途的药物（例如obeticholic Acid） 纳什。 鉴于退伍军人人口受到NAFLD的主要危险因素的影响不成比例（例如糖尿病， 肥胖），我们的中心假设是，初级保健中的退伍军人人口特别容易受到 NAFLD的高负担。目前尚不清楚VA目前是否能够处理这种昂贵的疾病 鉴于缺乏有关NAFLD的患病率，决定因素和临床认可的基本信息 VA。 磁共振成像的进步（MRI）已彻底改变了诊断和严重性分期 NAFLD，因此在大多数情况下消除了对肝活检的需求。但是，将MRI用于NAFLD筛选 在初级保健环境中是不切实际且昂贵的。没有商定的临床预测规则， 没有在VA设置中测试的。 我们将通过对1000名退伍军人进行基于概率的横截面研究来解决我们的假设（500名 男性和500名女性）参加了VA的主要医疗保健。 特定目的1：确定NAFLD的整体和种族和性别特异性患病率（并高级 肝纤维化）使用高度敏感和特定的MRI标准在大型和代表性的样本中 退伍军人在休斯敦的Michael E. Debakey VA医疗中心招收了其主要医疗保健。这 AIM将通过联合使用肝磁共振成像质子密度脂肪分数来实现 （MRI-PDFF）和弹性图（MRE）。 特定目的＃2：评估NAFLD的存在与严重性与潜在风险之间的关联 包括人口统计学（性别，种族/种族），人体测量学（BMI，腰围和身体）的因素 fat by bioimpedance analysis), clinical (medical history, family history, and medications), serologic (CD18), 遗传（PNPLA3），生化（LFT，肝纤维化和脂肪变性的血清学生物标志物），代谢 （代谢综合征的血清学标记）和生活方式（吸烟，酒精，运动）因素。 特定目的＃3：使用有关风险因素和生物标志物的信息来构建和验证算法 可以在初级保健级别使用，以识别NAFLD和NASH高风险的患者，以进一步 推荐。 有关不同群体患病率的信息对于有效的VA医疗保健计划至关重要 资源分配。该研究将有助于使用VA初级保健设置NAFLD的临床认可 VA特定的风险因素。最后，我们的研究将提供所需的数据来支持未来的研究以发展 检测和转诊的临床途径。