Madeline Erario

Association of nonalcoholic fatty liver disease (NAFLD) with hepatocellular carcinoma (HCC) in the United States from 2004 to 2009

Hepatocellular carcinoma (HCC) is increasingly reported in patients with nonalcoholic fatty liver disease (NAFLD). Our aim was to assess the prevalence and mortality of patients with NAFLD‐HCC. We examined Surveillance, Epidemiology and End Results (SEER) registries (2004‐2009) with Medicare‐linkage files for HCC, which was identified by the International Classification of Diseases for Oncology, third edition codes using topography and morphology codes 8170‐8175. Medicare‐linked data was used to identify NAFLD, hepatitis C virus (HCV), hepatitis B virus (HBV), alcoholic liver disease (ALD), and other liver disease using International Classification of Diseases, Ninth Revision, Clinical Modification codes. NAFLD was also defined by clinical diagnosis (cryptogenic cirrhosis, obese‐diabetics with cryptogenic liver disease). A logistic regression model was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for risk of HCC. In addition, adjusted hazard ratios for 1‐year mortality were estimated by Coxs proportional hazard regression. A total of 4,929 HCC cases and 14,937 controls without HCC were included. Of the HCC cases, 54.9% were related to HCV, 16.4% to ALD, 14.1% to NAFLD, and 9.5% to HBV. Across the 6‐year period (2004 to 2009), the number of NAFLD‐HCC showed a 9% annual increase. NAFLD‐HCC were older, had shorter survival time, more heart disease, and were more likely to die from their primary liver cancer (all P < 0.0001). Of those who received a transplant after HCC (n = 488), only 5% were related to NAFLD‐HCC. In multivariate analysis, NAFLD increased the risk of 1‐year mortality (OR, 1.21; 95% CI: 1.01‐1.45). Additionally, older age, lower income, unstaged HCC increased risk of 1‐year mortality while receiving a liver transplant (LT), and having localized tumor stage were protective (all P < 0.05). Conclusions: NAFLD is becoming a major cause of HCC in the United States. NAFLD HCC is associated with shorter survival time, more advanced tumor stage, and lower possibility of receiving a LT. (Hepatology 2015;62:1723–1730)

Pistachio Nut Consumption and Serum Lipid Levels

Objective: Clinical and epidemiological studies have reported the beneficial effects of tree nuts and peanuts on serum lipid levels. We studied the effects of consuming 15% of the daily caloric intake in the form of pistachio nuts on the lipid profiles of free-living human subjects with primary, moderate hypercholesterolemia (serum cholesterol greater than 210 mg/dL). Methods: Design: Randomized crossover trial. Setting: Outpatient dietary counseling and blood analysis. Subjects: 15 subjects with moderate hypercholesterolemia. Intervention: Fours weeks of dietary modification with 15% caloric intake from pistachio nuts. Measures of Outcome: Endpoints were serum lipid levels of total cholesterol, HDL-C, LDL-C, VLDL-C, triglycerides and apolipoproteins A-1 and B-100. BMI, blood pressure, and nutrient intake (total energy, fat, protein, and fiber) were also measured at baseline, during, and after dietary intervention. Results: No statistically significant differences were observed for total energy or percent of energy from protein, carbohydrate or fat. On the pistachio nut diet, a statistically significant decrease was seen for percent energy from saturated fat (mean difference, −2.7%; 95% CI, −5.4% to −0.08%; p = 0.04). On the pistachio nut diet, statistically significant increases were seen for percent energy from polyunsaturated fat (mean difference, 6.5%; 95% CI, 4.2% to 8.9%; p<.0001) and fiber intake (mean difference, 15g; 95% CI, 8.4g to 22g; p = 0.0003). On the pistachio diet, statistically significant reductions were seen in TC/HDL-C (mean difference, −0.38; 95% CI, −0.57 to −0.19; p = 0.001), LDL-C/HDL-C (mean difference, −0.40; 95% CI, −0.66 to −0.15; p = 0.004), B-100/A-1 (mean difference, −0.11; 95% CI, −0.19 to −0.03; p = 0.009) and a statistically significant increase was seen in HDL-C (mean difference, 2.3; 95% CI, 0.48 to 4.0; p = 0.02). No statistically significant differences were seen for total cholesterol, triglycerides, LDL-C, VLDL-C, apolipoprotein A-1 or apolipoprotein B-100. No changes were observed in BMI or blood pressure. Conclusion: A diet consisting of 15% of calories as pistachio nuts (about 2–3 ounces per day) over a four week period can favorably improve some lipid profiles in subjects with moderate hypercholesterolemia and may reduce risk of coronary disease.

The inpatient economic and mortality impact of hepatocellular carcinoma from 2005 to 2009: analysis of the US nationwide inpatient sample.

Hepatocellular carcinoma (HCC) is an important complication of cirrhosis. Our aim was to assess the inpatient economic and mortality of HCC in the USA

Inpatient economic and mortality assessment for liver transplantation: a nationwide study of the United States data from 2005 to 2009.

Background Liver transplantation is a standard of care for treatment of end-stage liver disease. The aim of this study was to evaluate resource utilization for patients admitted to the U.S. hospitals for liver transplantation from 2005 to 2009. Methods Nationwide inpatient sample was used. Results A total of 5527 hospital admissions were included to the study cohort approximating 27,350 procedures nationwide (compared with 32,228 reported by United Network for Organ Sharing). Approximately 75% of patients had major or extreme severity of illness (All Patient Refined Diagnosis-Related Groups). The most prevalent comorbidities were coagulopathy (36.0%), fluid and electrolyte disorders (39.8%), anemia (18.7%), and type 2 diabetes (23.8%). Furthermore, 5.1% patients died in the hospital, 80.0% were discharged routinely or to home healthcare, and 14.9% were transferred to other healthcare facilities. The mean number of inpatient procedures was 7.2, and 3.5 were minimal therapeutic. The mean length of hospitalization was 22.2 days, the mean hospital charges were

Nonalcoholic Fatty Liver Disease in Adults: The Impact of Diet and Other Therapeutic Interventions on Clinical and Histological Outcomes

358,200, and the mean inpatient costs of liver transplantation were

Is Exercise Treadmill Time or Reduction in Myocardial Ischemia the Appropriate Primary Endpoint to Assess Success of Percutaneous Coronary Intervention in Stable Angina (ORBITA)

114,300. In multivariate analysis, the most significant factors associated with longer stay were younger age, major or extreme severity of illness, and more procedures performed during hospitalization. Similar factors were also associated with higher cost of inpatient treatment. Inpatient mortality, however, was associated only with more severe illness and more procedures while being inversely associated with younger age and higher income. Conclusions Liver transplantation is a life-saving procedure with significant economic burden to our society. Severity of illness is the common driver of both in hospital mortality and resource utilization.

1334 CLINICAL AND ANTHROPOMETRIC FACTORS ASSOCIATED WITH LIVER-SPECIFIC MORTALITY IN SUBJECTS WITH NON ALCOHOLIC FATTY LIVER DISEASE (NAFLD)

Nonalcoholic fatty liver disease (NAFLD) is generally characterized by hepatic steatosis by imaging or histology in the absence of secondary causes for hepatic fat accumulation, such as significant alcohol consumption, hepatitis C or other chronic liver disease, hereditary disorders, or steatogenic medications. NAFLD is further subgrouped into nonalcoholic steatohepatitis (NASH) and simple steatosis depending on the histological presence of inflammation with hepatocellular injury in the former (NASH) and lack of hepatocyte injury in the latter. The natural history of simple steatosis is a very slow or no histological progression of simple steatosis. In contrast, NASH can exhibit rapid histological progression and ultimately develop cirrhosis [1, 2]. Accordingly, patients with NASH, but not simple steatosis, have an increased liver-related mortality. However, NAFLD patients as a group have a higher overall mortality compared to matched control populations, with cardiovascular disease being the leading cause of death both subgroups [3–8].

Statin use is not associated with liver related mortality

In patients with severe single-vessel coronary artery stenosis and stable angina, the Percutaneous Coronary Intervention (PCI) in Stable Angina (ORBITA) clinical trial showed improvement in myocardial ischemia more with PCI than with the placebo procedure as assessed by dobutamine stress echocardiography (1). However, reduction in stress-induced myocardial ischemia was designated to be a secondary endpoint in the ORBITA trial. Instead, it was exercise treadmill time that was selected as the primary endpoint for the clinical trial. While relief of angina, in terms of stability, severity, and frequency did not differ between PCI and placebo procedure groups, it would have been extremely important to determine whether the angina relief was greater in the subset of patients who had improvement in the myocardial ischemia index by echocardiography (indicating successful reperfusion with PCI) when compared to those that did not demonstrate reduction in echo-guided myocardial ischemia.

O041 : Increasing association of non-alcoholic fatty liver disease (NAFLD) with hepatocellular carcinoma in the United States: Data from surveillance, epidemiology and end results (SEER)-Medicare registries (2004–2009)

counts from accelerometer readings (ActiGraph, Fort Walton Beach, FL) were available. For each participant, activity counts from 7 consecutive days were used to assess overall activity levels (counts/min/d), and time spent in different levels of activity (sedentary, 60 in the absence of all other causes of chronic liver disease (e.g. HCV antibody, HBV surface antigen negative, normal transferrin saturation and alcohol consumption 3.0) and type 2 diabetes (all P-values <0.01). Average physical activity for NAFLD subjects was 28.7cnt/min/day less than controls (P < 0.01). Furthermore, NAFLD subjects spent less time participating in activity at any level (P < 0.01) than controls. A negative association was noted between physical activity levels and NAFLD (P < 0.01). The lowest quartile of average physical activity as well as moderatevigorous physical activity were associated with an increased likelihood of having NAFLD (P < 0.01). Conclusion: Data from this large population study show that NAFLD patients have low level of physical activity and perform at the lowest quartile of moderate-vigorous physical activity.