Maria Aguilar

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.

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.

The impact of pretransplant hepatic encephalopathy on survival following liver transplantation.

Hepatic encephalopathy (HE) is a surrogate marker of liver disease severity, and more severe HE is associated with higher mortality among patients with chronic liver disease. However, whether severity of HE at the time of liver transplantation (LT) directly impacts post‐LT survival or whether this suspected mortality linkage is due to more severe liver disease and subsequently higher rates of post‐LT infection is not well defined. Using population‐based data from the 2003 to 2013 United Network for Organ Sharing registry, we evaluated the impact of HE at the time of LT on post‐LT survival among adults in the United States. Survival was stratified by HE severity (none, grade 1‐2, grade 3‐4) and Model for End‐Stage Liver Disease score and was evaluated using Kaplan‐Meier methods and multivariate Cox proportional hazards models. From 2003 to 2013, 59,937 patients underwent LT (36.1%, no HE; 53.8%, grade 1‐2 HE; 10.2%, grade 3‐4 HE). Compared to no HE, patients with grade 3‐4 HE had significantly lower overall post‐LT survival (1‐year, 82.5% versus 90.3%; P < 0.001; 5‐year, 69.1% versus 74.4%; P < 0.001). On multivariate regression, grade 3‐4 HE was independently associated with lower overall post‐LT survival (HR, 1.27; 95% CI, 1.17‐1.39; P < 0.001). However, the increased mortality associated with HE is observed primarily within the first year following LT and was a reflection of higher rates of infection‐related deaths among patients with more severe HE. In conclusion, grade 3‐4 HE at the time of LT is associated with lower post‐LT survival, with a proposed direct or indirect association of more severe HE before LT with increased rates of post‐LT infections. Increased awareness and vigilance toward treating HE before LT and more aggressive monitoring and treatment for infections in the perioperative setting may improve LT outcomes. Liver Transpl 21:873‐880, 2015.

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

BACKGROUND & AIMS Individuals 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. METHODS A 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. RESULTS The 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). CONCLUSIONS The 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.

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 (age > 18 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 (P < 0.001). 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; P = 0.01; EtOH‐HCC—OR, 0.72; 95% CI, 0.59‐0.89; P = 0.002). Compared with HCV‐HCC patients, NASH‐HCC (HR, 0.83; 95% CI 0.76‐0.90; P < 0.001), EtOH‐HCC (HR, 0.88; 95% CI 0.81‐0.96; P = 0.002), and EtOH/HCV‐HCC (HR, 0.92; 95% CI 0.85‐0.99; P = 0.03) 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; P < 0.001; EtOH‐HCC—HR, 0.22; 95% CI, 0.18‐0.26; P < 0.001; EtOH/HCV‐HCC—HR, 0.26; 95% CI, 0.22‐0.32; P < 0.001). 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.

Improvements in hepatitis B virus screening before rituximab therapy: A community‐based, safety‐net hospital experience

Individuals with chronic hepatitis B virus infection (HBV) or previously resolved HBV are at increased risk of HBV exacerbation or reactivation when they receive treatment with anti‐CD20 monoclonal antibodies (against B‐lymphocyte antigen cluster of differentiation 20 [CD20], an activated‐glycosylated phosphoprotein) like rituximab (RTX). The objective of the current study was to evaluate the rates of appropriate HBV screening before patients started receiving RTX, at the initiation of HBV treatment, and during HBV flares among an underserved safety‐net population.

Impact of obesity and diabetes on waitlist survival, probability of liver transplantation and post-transplant survival among chronic hepatitis C virus patients

The rising prevalence of obesity and diabetes mellitus (DM) among hepatitis C virus (HCV) patients contributes to concurrent nonalcoholic fatty liver disease (NAFLD). We aim to evaluate the impact of concurrent obesity or DM on waitlist survival and probability of liver transplantation (LT) among adults with chronic HCV awaiting LT.

Females, Hispanics and older individuals are at greatest risk of developing metabolic syndrome in the U.S.

BACKGROUND The increasing prevalence of metabolic syndrome (MetS) and MetS related complications in the U.S. poses a serious public health burden. We aim to identify high risk groups at greatest risk of developing MetS in the U.S. METHODS Using data from the 2001-2012 National Health and Nutrition Examination Survey (NHANES), MetS prevalence among adults (age≥18) was stratified by sex, race/ethnicity and age to identify groups at greatest risk of MetS. Mutlivariate logistic regression models evaluated for predictors of MetS. RESULTS Overall, the prevalence of MetS in the U.S. was 78 million during the study period. There was a greater prevalence of MetS in females compared to males (34.4% vs. 29.6%, p<0.001). Females had a 25% higher risk of MetS compared to males (OR, 1.25; 95% CI, 1.18-1.32, p<0.001). Hispanics had a higher risk of MetS when compared to non-Hispanic whites (OR, 1.13; 95% CI, 1.04-1.23, p<0.01). The prevalence of MetS increased with increasing age (age <40: 17.5% vs. age 40-49: 29.7% vs. age 50-59: 37.5% vs. age 60-69: 44.4% vs. age ≥70: 47.0%, p<0.001), and individuals age 70 and over were more than 5 times more likely to have MetS than those less than age 40 (OR, 5.12, 4.71-5.57, p<0.001) CONCLUSIONS: The high prevalence of MetS in the U.S. affects females, Hispanics, and older individuals the greatest. The aging population and increasing Hispanic population further highlight the huge burden of disease MetS will place on the healthcare system in the U.S.