Benny Liu

Prevalence of the Metabolic Syndrome in the United States, 2003-2012

Prevalence of the Metabolic Syndrome in the United States, 2003-2012 The metabolic syndrome contributes to cardiovascular morbidity and mortality.1-4 Data from the National Health and Nutrition Examination Survey (NHANES) 1999-2006 reported a metabolic syndrome prevalence of 34%.5 Understanding updated prevalence trends may be important given the potential effect of the metabolic syndrome and its associated health complications on the aging US population. We investigated trends in the prevalence of the metabolic syndrome through 2012.

Concurrent Obesity, Diabetes, and Steatosis Increase Risk of Advanced Fibrosis Among HCV Patients: A Systematic Review.

BackgroundRising rates of obesity, diabetes mellitus (DM), and nonalcoholic fatty liver disease among patients with chronic hepatitis C virus infection (HCV) may contribute to more rapid disease progression.AimTo evaluate the impact of concurrent obesity, DM, and steatosis on disease progression among HCV patients.MethodsA systematic review using structured keyword search of MEDLINE and EMBASE from January 1, 2001, to July 1, 2014, was performed to identify original articles evaluating the association of obesity, DM, and steatosis with advanced fibrosis (AF) among adults with chronic HCV. Studies involving HCV patients coinfected with human immunodeficiency virus, hepatitis B virus, hepatocellular carcinoma, or other chronic liver diseases were excluded. Quality assessment utilized Newcastle–Ottawa Scale.ResultsTwenty cohort studies met inclusion criteria for analyses. Obesity was associated with increased risk of AF in seven studies with effect size ranging from OR 1.08 to 7.69. However, four studies did not demonstrate a significant association between obesity and AF. The presence of advanced steatosis among HCV patients was associated with increased risk of AF in 12 studies (OR 1.80–14.3). Concurrent DM was associated with increased risk of AF in six studies (OR 2.25–9.24). Thirteen studies were good quality, and seven studies were fair quality.ConclusionConcurrent DM and steatosis are associated with increased risk of AF among chronic HCV patients. The majority of studies demonstrated significant associations of obesity with AF. Targeted interventions to optimize management of obesity-related diseases among HCV patients may help mitigate HCV disease progression.

Diabetes Mellitus Increases Risk of Hepatocellular Carcinoma in Chronic Hepatitis C Virus Patients: A Systematic Review

BackgroundRising rates of obesity, diabetes mellitus (DM), and nonalcoholic fatty liver disease (NAFLD) among chronic hepatitis C (HCV) patients may contribute to higher hepatocellular carcinoma (HCC) risk.AimTo perform a systematic review evaluating the impact of DM, body mass index (BMI), or steatosis on HCC risk among chronic HCV patients.MethodsA structured keyword search of PubMed from January 1, 2001, to July 1, 2014, was performed to identify original articles evaluating the association of DM, BMI, or steatosis with HCC among adults with chronic HCV. Studies involving HCV patients co-infected with human immunodeficiency virus, hepatitis B virus, or other chronic liver diseases with the exception of NAFLD were excluded. Quality assessment utilized the Newcastle–Ottawa scale.ResultsNine studies (seven cohorts, two case–controls) met inclusion criteria for the final analysis. Five of seven studies analyzing DM demonstrated significantly increased HCC risk associated with concurrent DM with effect sizes ranging from HR 1.73 (95xa0% CI 1.30–2.30) to RR 3.52 (95xa0% CI 1.29–9.24). One of three studies analyzing BMI demonstrated a significant association with HCC risk (BMIxa0≥xa030.0 vs. BMIxa0<xa023: RR 4.13, 95xa0% CI 1.38–12.40). Two of the three studies analyzing steatosis demonstrated significantly higher risk of HCC associated with steatosis ranging from RR 2.81 (95xa0% CI 1.49–4.41) to OR 6.39 (95xa0% CI 1.04–39.35).ConclusionsConcurrent DM is associated with increased HCC risk among chronic HCV patients. BMI and steatosis may also increase HCC risk, but the limitations of the current studies do not allow us to draw strong conclusions.

Race/ethnicity-specific disparities in cancer incidence, burden of disease, and overall survival among patients with hepatocellular carcinoma in the United States

Hepatocellular carcinoma (HCC) is one of the fastest rising causes of cancer‐related deaths in the United States, with disparities observed in cancer incidence and survival between ethnic groups. This report provides updated analyses on race‐specific disparities in US HCC trends.

Birth cohort-specific disparities in hepatocellular carcinoma stage at diagnosis, treatment, and long-term survival.

BACKGROUND & AIMSnIndividuals born between 1945 and 1965 account for nearly 75% of hepatitis C virus (HCV) infections in the United States. As this cohort ages, progressive HCV-related liver disease leading to cirrhosis and hepatocellular carcinoma (HCC) will place a significant burden on the healthcare system. We aim to evaluate birth cohort-specific disparities in HCC stage at diagnosis, treatment rates, and overall survival with a focus on the 1945-1965 birth cohort.nnnMETHODSnA population-based retrospective cohort study of adult patients with HCC identified in the Surveillance, Epidemiology, and End Results 2003-2011 registry evaluated birth cohort-specific disparities in the prevalence and outcomes of HCC, including multivariate logistic regression models to evaluate disparities in HCC stage at diagnosis and HCC treatment received. Birth cohort-specific survival was evaluated with Kaplan-Meier methods and multivariate Cox proportional hazard models.nnnRESULTSnThe proportion of HCC represented by the 1945-1965 cohort increased by 64% from 2003-2011, and accounted for 57.4% of all HCC in 2011. Compared to patients born after 1965, the 1945-1965 cohort were more likely to have HCC within Milan criteria (OR, 3.66; 95% CI, 3.13-4.28; p<0.001). However, among patients with HCC within Milan criteria, the 1945-1965 cohort had no difference in receipt of surgical treatment, but had higher overall long-term survival (HR, 0.82; 95% CI, 0.69-0.97; p<0.03).nnnCONCLUSIONSnThe 1945-1965 birth cohort accounts for the majority of HCC in the United States. Despite earlier HCC stage at diagnosis, no difference in receipt of surgical treatment was observed, but higher overall survival was achieved.

Race/Ethnicity-specific Disparities in Hepatocellular Carcinoma Stage at Diagnosis and its Impact on Receipt of Curative Therapies.

Goals:To evaluate race/ethnicity-specific disparities in hepatocellular carcinoma (HCC) stage at diagnosis and how this impacts receiving curative therapies. Background:HCC is a leading cause of morbidity and mortality worldwide. The highest incidence of HCC is seen among ethnic minorities in the United States. Study:Using the 2003-2011 Surveillance, Epidemiology, and End Results database and United Network of Organ Sharing, population-based registries for cancer and liver transplantation (LT) in the United States, race/ethnicity-specific cancer stage at diagnosis and treatment received among adults with HCC were evaluated. Results:Compared with non-Hispanic whites, blacks had significantly more advanced HCC at diagnosis [odds ratio (OR), 1.20; 95% confidence interval (CI), 1.10-1.30; P<0.001], whereas Asians were less likely to have advanced disease (OR, 0.87; CI, 0.80-0.94; P<0.001). Among patients with HCC meeting Milan criteria, Hispanics (OR, 0.64; 95% CI, 0.57-0.71; P<0.001) and blacks (OR, 0.67; 95% CI, 0.59-0.76; P<0.001) were significantly less likely to receive curative therapy (resection or LT), whereas Asians were more likely to receive curative therapy (OR, 1.22; 95% CI, 1.10-1.35; P<0.001) compared with non-Hispanic whites. However, Asians (OR, 0.49; 95% CI, 0.42-0.58; P<0.001) and Hispanics (OR, 0.51; 95% CI, 0.44-0.60; P<0.001) were less likely to receive LT. Conclusions:Among US adults with HCC, blacks consistently had more advanced stage at diagnosis and lower rates of receiving treatment. After correcting for cancer stage and evaluating the subset of patients eligible for curative therapies, blacks and Hispanics had significantly lower rates of curative HCC treatment.

Sex-specific and race/ethnicity-specific disparities in cholangiocarcinoma incidence and prevalence in the USA: An updated analysis of the 2000-2011 Surveillance, Epidemiology and End Results registry.

Cholangiocarcinoma (CCA) is an uncommon but lethal malignancy with an increasing worldwide incidence of intrahepatic cholangiocarcinoma (ICC), but decreasing incidence of extrahepatic cholangiocarcinoma (ECC). To evaluate age‐specific, sex‐specific, race/ethnicity‐specific variations in CCA incidence in the USA.

Lower rates of receiving model for end‐stage liver disease exception and longer time to transplant among nonalcoholic steatohepatitis hepatocellular carcinoma

Receiving Model for End‐Stage Liver Disease (MELD) exception status for hepatocellular carcinoma (HCC) improves wait‐list survival and probability of liver transplantation (LT). We aim to evaluate etiology‐specific disparities in MELD exception, LT wait‐list times, and post‐LT outcomes among patients with HCC listed for LT. Using United Network for Organ Sharing 2004‐2013 data, we evaluated adults (ageu2009>u200918 years) with HCC secondary to hepatitis C virus (HCV), nonalcoholic steatohepatitis (NASH), alcoholic cirrhosis (EtOH), hepatitis B virus (HBV), combined EtOH/HCV, and combined HBV/HCV. Multivariate regression models evaluated etiology‐specific odds of active exception, probability of receiving LT, and post‐LT survival. In total, 10,887 HCC patients were listed for LT from 2004 to 2013. Compared with HCV‐HCC patients (86.8%), patients with NASH‐HCC (67.7%), and EtOH‐HCC (64.4%) had a lower proportion with active MELD exception (Pu2009<u20090.001). On multivariate regression, NASH‐HCC and EtOH‐HCC patients had significantly lower odds of active MELD exception compared with HCV‐HCC (NASH‐HCC—odds ratio [OR], 0.73; 95% confidence interval [CI], 0.58‐0.93; Pu2009=u20090.01; EtOH‐HCC—OR, 0.72; 95% CI, 0.59‐0.89; Pu2009=u20090.002). Compared with HCV‐HCC patients, NASH‐HCC (HR, 0.83; 95% CI 0.76‐0.90; Pu2009<u20090.001), EtOH‐HCC (HR, 0.88; 95% CI 0.81‐0.96; Pu2009=u20090.002), and EtOH/HCV‐HCC (HR, 0.92; 95% CI 0.85‐0.99; Pu2009=u20090.03) were less likely to receive LT if they had active exception. Without active exception, these discrepancies were more significant (NASH‐HCC—HR, 0.22; 95% CI, 0.18‐0.27; Pu2009<u20090.001; EtOH‐HCC—HR, 0.22; 95% CI, 0.18‐0.26; Pu2009<u20090.001; EtOH/HCV‐HCC—HR, 0.26; 95% CI, 0.22‐0.32; Pu2009<u20090.001). In conclusion, among US adults with HCC listed for LT, patients with NASH‐HCC, EtOH‐HCC, and EtOH/HCV‐HCC were significantly less likely to have active MELD exception compared with HCV‐HCC, and those without active exception had a lower likelihood of receiving LT. More research is needed to explore why NASH‐HCC patients were less likely to have active MELD exception. Liver Transplantation 22 1356–1366 2016 AASLD.

Cirrhosis Patients with Nonalcoholic Steatohepatitis Are Significantly Less Likely to Receive Surveillance for Hepatocellular Carcinoma

BackgroundDisparities in receipt of hepatocellular carcinoma (HCC) surveillance contribute to disparities in overall survival outcomes.AimWe aim to evaluate disparities in receipt of routine HCC surveillance among patients with cirrhosis in a large urban safety-net hospital.MethodsConsecutive adults (agexa0≥xa018) with cirrhosis from July 1, 2014, to December 31, 2015, were retrospectively evaluated to determine rates of receiving appropriate HCC surveillance within 6xa0months and 1xa0year after diagnosis of cirrhosis. Rates of HCC surveillance were stratified by sex, race/ethnicity, and liver disease etiology. Multivariate Cox proportional hazards models were utilized to evaluate for predictors of receiving appropriate HCC surveillance.ResultsAmong 157 cirrhosis patients enrolled [hepatitis C virus (HCV): 29.9%, hepatitis B virus: 13.4%, alcoholic cirrhosis: 44.6%, nonalcoholic steatohepatitis (NASH): 8.9%], mean age of cirrhosis diagnosis was 53.8xa0±xa09.0xa0years. Among these patients, 49% received (nxa0=xa077) HCC surveillance within 6xa0months and 78% (nxa0=xa0123) were surveyed within 1xa0year of cirrhosis diagnosis. On multivariate analyses, patients with NASH cirrhosis were significantly less likely to receive HCC surveillance compared with chronic HCV cirrhosis patients (HR 0.44, 95% CI 0.19–0.99, pxa0<xa00.05). No significant sex-specific or race/ethnicity-specific disparities in receipt of HCC surveillance were observed.ConclusionAmong a diverse safety-net hospital population, sub-optimal HCC surveillance rates were observed: Only 49% of cirrhosis patients received HCC surveillance within 6xa0months, and 78% of cirrhosis patients received HCC surveillance within 1xa0year. Differences in rates of HCC screening by liver disease etiology were observed.

Significant disparities in risks of diabetes mellitus and metabolic syndrome among chronic hepatitis C virus patients in the U.S.

AIMnDiabetes mellitus (DM) and metabolic syndrome (MetSyn) among chronic hepatitis C virus (HCV) patients increases risks for nonalcoholic fatty liver disease (NAFLD) and more rapid progression to hepatocellular carcinoma (HCC). We aim to evaluate the prevalence of DM and MetSyn among HCV patients, focusing on age-specific and race/ethnicity-specific disparities.nnnMETHODSnWe retrospectively evaluated 2003-2012 National Health and Nutrition Examination Survey (NHANES) data for age and race disparities in concurrent DM and MetSyn among HCV patients. Multivariate logistic regression models evaluated for independent predictors of DM and MetSyn among HCV patients.nnnRESULTSnOverall U.S. prevalence of HCV was 1.29% from 2003 to 2012 and prevalence of DM and MetSyn among HCV patients was 17.5% and 35.0%, respectively. Higher rates of DM (36.9% vs. 3.3%, p<0.001) and MetSyn (50.5% vs. 11.7%, p<0.001) were seen among HCV patients ≥60 compared to <40years. The highest rates of DM and MetSyn were seen among African Americans (AA) (DM: 39.1%, MetSyn: 29.2%) and the lowest in non-Hispanic whites (DM: 9.4%, MetSyn: 33.0%). On multivariate regression, patients ≥60 were significantly more likely to have DM compared to patients <40 years (OR 11.90, 95% CI 2.73-52.60, p=0.001); AA were significantly more likely to have DM compared to non-Hispanic whites (OR 2.82, 95% CI 1.53-5.20, p=0.001).nnnCONCLUSIONnAmong chronic HCV patients, the highest risk of DM and MetSyn was seen among older patients, African Americans, and women. These groups are at higher risk of cirrhosis and HCC due to concurrent NAFLD.