James Paik

Cognitive Performance in Individuals With NonAlcoholic Fatty Liver Disease and/or Type 2 Diabetes Mellitus

BACKGROUNDnIndividuals with nonalcoholic fatty liver disease (NAFLD) share some common pathophysiological features with individuals with type 2 diabetes mellitus (T2DM). There is a well-established association between T2DM and cognitive decline, but no corollary data of people with NAFLD and without T2DM or whether combination of the 2 disorders is associated with additive deficitsxa0in cognitive performance.nnnOBJECTIVESnThe purpose of this investigation is to compare measures of cognitive performance for individuals with NAFLD, individuals with T2DM, individuals with both or neither.nnnMETHODSnUsing NHANES data from 2011-2014, 1102 individuals were identified who had completed cognitive assessments.nnnRESULTSnAfter controlling for demographics, comorbidities, and metabolic components, individuals with both NAFLD and T2DM scored significantly lower on a task that combines processing speed, sustained attention, and working memory (Beta = -3.44, 95% CI: -6.75 to -0.12) than individuals with neither. Individuals with T2DM without NAFLD scored significantly lower on verbal fluency (Beta = -1.47, 95% CI: -2.7 to -0.23) than individuals with neither.nnnCONCLUSIONSnData from this study suggests that individuals with T2DM and individuals with both NAFLD and T2DM have lower cognitive performance on various tasks. These data support an approach that aims to apply preventive strategies to optimize management of T2DM in patients with NAFLD.

Chronic Kidney Disease is Independently Associated with Increased Mortality in Patients with Non-alcoholic Fatty Liver Disease

Nonalcoholic fatty liver disease and chronic kidney disease share similar pathophysiologic features. Our aim was to assess the association between different stages of chronic kidney disease and mortality in patients with nonalcoholic fatty liver disease.

Among Patients With NAFLD, Treatment of Dyslipidemia Does Not Reduce Cardiovascular Mortality

Dyslipidemia is one of the common risk factors for NAFLD and is associated with cardiovascular (CV) mortality, which is the most common cause of death in NAFLD. Lipid‐lowering agents (LLAs) are used to reduce CV events in the general population. Our aim was to assess whether the use of LLAs in patients with NAFLD can reduce the risk of CV mortality. We used the third National Health and Nutrition Examination Survey mortality linked files. Mortality was determined from the National Death Index records through 2011. NAFLD was diagnosed by ultrasound after exclusion of other causes of liver disease. After inclusion and exclusion, the cohort consisted of 2,566 patients with NAFLD (45.8% < 45 years of age, 52.8% male, 75.4% white). Those who were taking LLAs were more likely to be older, non‐Hispanic white, and had significantly higher rates of diabetes mellitus (DM), hyperlipidemia, hypertension, metabolic syndrome, and history of CV disease (CVD) (all P< 0.01). In our multivariate analysis, DM was an independent predictor of overall mortality (adjusted hazard ratio [aHR]: 1.79 [95% confidence interval (CI): 1.40‐2.30]) and CV mortality (aHR: 1.89 [95% CI: 1.08‐3.30]). History of CVD was associated with both overall (aHR: 2.03 [95% CI: 1.57‐2.63]) and CV mortality (aHR: 3.69 [95% CI: 2.23‐6.08]). In contrast, the use of statins and other LLAs was not associated with reduction in overall (aHR = 0.95 [95% CI: 0.37‐2.44] and aHR = 1.43 [95% CI: 0.99‐2.07]) and CV mortality (aHR = 1.20 [95% CI: 0.26‐5.54] and aHR = 1.63 [95% CI: 0.70‐3.76]). Conclusion: The use of statins and other LLAs did not reduce the increased risk of overall or CV mortality in NAFLD.

Patients With Lean Nonalcoholic Fatty Liver Disease Are Metabolically Abnormal and Have a Higher Risk for Mortality

IN BRIEF Nonalcoholic fatty liver disease (NAFLD) is an increasingly recognized and common cause of chronic liver disease worldwide. Although most patients with NAFLD are obese, a smaller group of NAFLD patients are lean. This study explored the long-term outcomes of lean patients with NAFLD in the United States. Compared to lean individuals without NAFLD, lean people with NAFLD were significantly more likely to be older and male and had higher comorbidities (i.e., diabetes, hyperlipidemia, hypertension, metabolic syndrome, chronic kidney disease, and cardiovascular disease). The presence of NAFLD in lean individuals was independently associated with increased risk of all-cause and cardiovascular mortality.