Nonalcoholic Fatty Liver Disease: An Expanding Health Care Epidemic

Clinics in Liver Disease

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February 2018
NASH and NAFLD

Nonalcoholic Fatty Liver Disease: An Expanding Health Care Epidemic
David E. Bernstein, MD, Editor

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Nonalcoholic fatty liver disease (NAFLD) has become a common worldwide condition, the prevalence of which continues to increase with the worldwide surge in the incidence of obesity and diabetes. In the United States alone, NAFLD affects between 60 and 100 million people, including 10% of American children. The spectrum of disease ranges from simple, nonclinically significant hepatic steatosis to steatohepatitis (NASH) to cirrhosis, hepatocellular carcinoma, and decompensated liver disease. In 2016, NAFLD was reported to surpass hepatitis C as the leading indication for liver transplantation among adults under the age of 50, and it is predicted to be the leading indication for liver transplantation in the next decade (Banini and Sanyal, Am J Gastroenterol 2016, Vol 111; Abstract 46).

NAFLD/NASH is the hepatic manifestation of the metabolic syndrome and therefore associated with hypertension, hyperlipidemia, diabetes, and obesity. Despite this association, NAFLD may occur in nondiabetic, nonobese individuals, suggesting that multiple mechanisms may exist for its development. Over the past decade, there have been significant advances in our understanding of the prevalence, natural history, genetics, evaluation, and treatment of NAFLD.

This issue of Clinics in Liver Disease provides an update to our current understanding of NAFLD as presented by a cadre of distinguished experts in the field. The first section reviews its clinical and economic burden, discusses the implication of NAFLD in children, and reviews the natural history of the disease. The second section discusses the diagnosis and evaluation of NAFLD/NASH, focusing on noninvasive serological markers, the role of liver biopsy, and an in-depth discussion of the use of radiological imaging. The third section concentrates on the pathophysiology, risk factors, genetics, and the role of intestinal microbes in the disease. The final section discusses associated conditions, reviews current and emerging treatments, and discusses the development of hepatocellular carcinoma and the role of liver transplantation in NAFLD/NASH.

Our understanding of NAFLD/NASH continues to grow at a rapid pace, and keeping up with the latest information can be challenging. The contributors to this issue have worked hard to provide excellent, concise, up-to-date reviews of the topics listed above. I hope you enjoy their work, and I thank them all for their contributions

Begin here:
February 2018 Volume 22, Issue 1, p1-228

NASH and NAFLD

Edited by David E. Bernstein

Cutting back on alcohol can prevent cancers: experts

Cutting back on alcohol can prevent cancers: experts

Last Updated: 2017-11-07

By Cheryl Platzman Weinstock

..alcohol consumption is known to increase the risk of several cancers, including head and neck, esophageal, liver, colorectal and female breast cancers.

(Reuters Health) - A large organization of cancer doctors has issued a call to action to minimize alcohol consumption.

With a newly released position paper, the American Society of Clinical Oncology (ASCO) hopes to draw attention to the strong links between drinking alcohol and risks for several types of cancer.
"People are not aware of this," said Susan Gapstur, a vice-president of the American Cancer Society who was not involved with the position statement.

In a phone interview, Gapstur stressed that people living with cancer remain at risk for other cancers so it's important that they realize alcohol's role in cancer recurrence, too.

The call to action from ASCO follows a survey the group commissioned, which found that 70% of Americans do not recognize drinking alcohol as a risk factor for cancer. In fact, alcohol consumption is known to increase the risk of several cancers, including head and neck, esophageal, liver, colorectal and female breast cancers.

Read more: http://www.chronicliverdisease.org/reuters/article.cfm?article=20171107Other532649162

Coffee May Increase Life Expectancy in Liver Disease

Perspective > Hepatology Highlights   

COMMENTARY

Coffee May Increase Life Expectancy in Liver Disease
Rowen K. Zetterman, MD

Two recent publications from the United States and Europe have again focused attention on the positive effects of coffee in reducing all-cause human mortality.^[1,2] Furthermore, other studies are adding to our knowledge of coffee's potential ability to reduce the risk for liver disease and its progression. These studies led me to update the information regarding coffee and its beneficial clinical effects.

Coffee is consumed worldwide. Although we may not yet understand the mechanisms of coffee's positive effects,^[3,4] a growing number of publications continue to indicate that it can benefit persons with liver disease, slow formation of liver fibrosis, reduce the risk for hepatocellular carcinoma even in persons without cirrhosis, and lower overall mortality in people with or without liver disease.

Read more: https://www.medscape.com/viewarticle/887970

Hepatitis November Newletters & Watch: Comprehensive Expert Review Of AASLD 2017

Newsletters
Welcome to this month's index of newsletters, with follow up links to basic information, research and current news about viral hepatitis.

HepCBC - The Week in Review
Read the latest issue of: Weekly Bull

HCV Advocate
HCV Advocate: November Newsletter
Updated fact sheets: Children and HCV.

In this month's newsletter results from a real-world study is summarized by Alan Franciscus, the study examined retreatment of HCV patients who developed NS5A resistance. Hepatitis C-related liver cancer is featured as well, from symptoms, diagnosis, prevention, to FDA approved medications to treat liver cancer. In addition, the always brilliant Lucinda K. Porter, writes about, "Living with Hepatitis C and Stress." A special thank you to Matthew Zielske, for his eloquent article exploring the sometimes frustrating, yet always amazing, side of advocacy.

Follow Up Link
Healio 
Focus On Children With Viral Hepatitis - 2017 World Hepatitis Summit
Focus on children with viral hepatitis
Recent data revealed that, worldwide, 52 million children are living with viral hepatitis, compared with 2.1 million children with HIV or AIDS, according to data presented at the World Hepatitis Summit 2017 in São Paulo, Brazil.

The 2017 World Hepatitis Summit is a joint initiative between the World Health Organization (WHO) and the World Hepatitis Alliance (WHA) to advance the viral hepatitis agenda.
News & Updates

Patient Support - I Help C
Karen Hoyt shares her own journey living with cirrhosis and liver cancer, to the emotional ups and downs of her lifesaving liver transplant. 
Blog
Videos

Recent articles: Long-Term Success After Hep C Treatment
Emergency Room Diagnosis with Liver Cirrhosis.

The New York City Hepatitis C Task Force

A few topics in the November Newsletter include; NYC Health Department’s 2016 Hepatitis B and C Annual Report, and upcoming activities.

Also mentioned in this months newsletter, is the following documentary highlighting the impact of hepatitis B on the Asian American community, released in October by Gilead.

Follow Up Link
Hepatitis B Foundation
If you have recently been diagnosed with hepatitis B, a new article helping patients cope with various stages of emotions associated with a new HBV diagnosis can be found online at Hep B Blog.
Link: Navigating Our Emotions When We’re First Diagnosed with Hepatitis B

British Liver Trust
All Newsletters
In The News
UK elimination of hepatitis C in jeopardy unless more patients found
Just one in three people with hepatitis C in the UK have been diagnosed according to the latest estimates released at this year’s World Hepatitis Summit in Sao Paulo, Brazil (1-3 November).

GI & Hepatology News

View all newsletters, here.

NIH News in Health

Check out the November NIH News In Health Newsletter, with practical health news and tips based on the latest NIH research.

New Online
ViralEd has started updating: Advances in Chronic Hepatitis C: Management and Treatment, an expert review of the 68th American Association for the Study of the Liver Diseases Annual Meeting (AASLD 2017). This program will feature HCV experts reviewing and discussing the most important studies on chronic hepatitis C presented at the meeting.

View the first presentation: Survival Benefit of Direct-Acting Antiviral Therapy in Patients with Decompensated Cirrhosis,and download the abstract, seven additional presentations coming soon.....

In Case You Missed It
National Viral Hepatitis Progress Report
Report highlighting the nation's progress toward reducing the burden of hepatitis A virus (HAV), hepatitis B virus (HBV), and hepatitis C virus (HCV) infections.

In The Journals 

Clinical Liver Disease - HCV treatment in patients with decompensated liver disease
Elizabeth C. Verna
Published 31 October, in Clinical Liver Disease (CLD)
Full Text (HTML)
Watch a video presentation of this article

Controversies in hepatitis C therapy: Reactivation of hepatitis B virus

Authors Sarah R. Lieber, Michael W. Fried

First Published: 31 October 2017 in Clinical Liver Disease (CLD)

Full Text (HTML)
Watch a video presentation of this article

BMC Infectious Diseases

Testing for chronic hepatitis B and C – a global perspective. 
An open access supplement published during the 2017 World Hepatitis Summit in BMC Infectious Diseases, relating to the WHO 2017 Guidelines on hepatitis B and C testing, provides an array of information to tackle accurate diagnostic testing for viral hepatitis.

Thanks for stopping by, enjoy the rest of your weekend.
Tina

Primary care program cost-effectively reaches underserved with HCV infection

Primary care program cost-effectively reaches underserved with HCV infection
Last Updated: 2017-11-03
By Marilynn Larkin

NEW YORK (Reuters Health) - The Extension for Community Healthcare Outcomes (Project ECHO) is a cost-effective way to find and treat underserved people with HCV infection using primary care providers, but incremental rollout is needed to mitigate high upfront costs, researchers say.

"To work towards the elimination of HCV - a World Health Organization goal - treatment rates must rise sharply," he observed. "The necessary drugs are still very expensive. They, too, were shown to be cost-effective, but some only barely so."

New drugs, such as the recently FDA-approved glecaprevir and pibrentasvir, marketed as Mavyret, "may bring down costs enough for HCV care to be affordable at a much larger scale," he suggested.

Read more:
http://www.chronicliverdisease.org/reuters/article.cfm?article=20171103Other2087406487

SOURCE: http://bit.ly/2xMgxNV
Gastroenterology 2017.

Hepatitis C is a huge public health problem in Canada

Hepatitis C could be eliminated in Canada, but drug prices, screening barriers stand in the way
By Nicole Ireland, CBC News Posted: Nov 03, 2017 1:42 AM ET

In a presentation to the World Hepatitis Summit in Sao Paulo on Thursday, Hill said 90 per cent of hepatitis C patients can now be cured in 12 weeks, at a cost of about $50 US per patient...

For Feld, the larger barrier to curing the estimated 250,000 people infected with the virus in this country is the absence of a "targeted, well-structured national plan" to actually reach those patients...

Feld advocates broadening screening in Canada to everyone born between 1945 and 1975 — a practice recommended by the Canadian Liver Foundation but rejected by the Canadian Task Force on Preventive Health Care....

Read more... http://www.cbc.ca/news/health/hepatitis-c-can-be-cured-in-canada-1.4385172?cmp=rss

Viral Hepatitis Hit 52 Million Children Worldwide – NGO

Viral Hepatitis Hit 52 Million Children Worldwide – NGO
World Hepatitis Alliance, in a report on Friday, children are suffering a huge burden of viral hepatitis worldwide, and the public health implications of this are enormous.

The analysis in the report was conducted by Manal El-Sayed, professor of pediatrics at Ain Shams University, Cairo, Egypt, and the Polaris Observatory, led by Dr. Homie Razavi with the Center for Disease Analysis Foundation in Colorado, the U.S. Raquel Peck, CEO of the World Hepatitis Alliance.

“Most infected infants and children are not diagnosed, prioritized or treated effectively,’’ Peck said.
Read more: https://www.frontiersnews.com/viral-hepatitis-hit-52-million-children-worldwide-ngo/

Focus on children with viral hepatitis imperative for elimination goals
November 3, 2017

Recent data revealed that, worldwide, 52 million children are living with viral hepatitis, compared with 2.1 million children with HIV or AIDS, according to data presented at the World Hepatitis Summit 2017 in São Paulo, Brazil.

“We must act and treat as many children as possible. The economic and social benefit of early hepatitis C treatment in children is substantial,” Manal El-Sayed, MD, professor of pediatrics at Ain Shams University, Cairo, Egypt, said in a related press release. “This includes avoiding disease progression, removing social stigma and improving activity and school performance, and reducing fatigue. However, the fundamental principle is to avoid transmission by adopting ‘cure as prevention’ at an early age and before high risk behaviors emerge that enable transmission.”
Read more: https://www.healio.com/hepatology/hepatitis-c/news/online/%7B8a1cc8fe-43db-4e18-9140-bbc9ccac0c58%7D/focus-on-children-with-viral-hepatitis-imperative-for-elimination-goals

BMC Supplement: “Testing for chronic hepatitis B and C – a global perspective.”

Open Access

Volume 17 Supplement 1

Testing for chronic hepatitis B and C – a global perspective

By Sonjelle Shilton | 02 Nov, 2017

Dear colleagues,
I am pleased to share this link to the BMC Infectious Diseases supplement, “Testing for chronic hepatitis B and C – a global perspective.”

This supplement, timed to coincide with the 2017 World Hepatitis Summit currently ongoing in Brazil, includes important articles relating to the WHO 2017 Guidelines on hepatitis B and C testing, provides a host of information regarding the current hepatitis B and C space and recommends next steps that we can take as a global health community to tackle these diseases. More specifically, the supplement presents research on the diagnostic accuracy of hepatitis B and C testing (including the use of dried blood spots), a target product profile for optimising diagnosis of viraemic HCV infection in low- and middle-income countries, economic evaluations of testing methods, ways forward to reaching equitable hepatitis B and C testing globally, and much more.

As FIND - together with partners such as WHO and others - continues to contribute to hepatitis C elimination through our HEAD*-Start project, we look forward to participating in an ongoing dialogue with the global health diagnostic community on challenges and lessons learned within this disease space.

*Hepatitis c Elimination through Access to Diagnostics
On behalf of Francesco Marinucci, Head of FIND HCV/HIV

Published on: 1 November 2017
BMC Infectious Diseases supplement, “Testing for chronic hepatitis B and C – a global perspective.” (external URL)

Link leads to: https://bmcinfectdis.biomedcentral.com/articles/supplements/volume-17-supplement-1