Mortality in biopsy-confirmed nonalcoholic fatty liver disease: results from a nationwide cohort

Conclusion All NAFLD histological stages were associated with significantly increased overall mortality, and this risk increased progressively with worsening NAFLD histology. Most of this excess mortality was from extrahepatic cancer and cirrhosis, while in contrast, the contributions of cardiovascular disease and HCC were modest.

Mortality in biopsy-confirmed nonalcoholic fatty liver disease: results from a nationwide cohort — https://gut.bmj.com/content/70/7/1375?rss=1

Also see previous posts:

NAFLD – Why are Life Insurers Taking This Risk at Standard Rates?

NAFLD

NAFLD and Obesity: What Is the Mortality Risk? | Medpage Today

NAFLD = Higher Mortality Rate

PPI’s and Gastric Cancer Risk

Objective The association between proton pump inhibitor (PPI) use and gastric cancer related to Helicobacter pylori eradication has not been fully investigated in geographical regions with high risk of gastric cancer. We aimed to evaluate the association between PPIs and gastric cancer in Korea.

Design This study analysed the original and common data model versions of the Korean National Health Insurance Service database from 2002 to 2013. We compared the incidence rates of gastric cancer after 1-year drug exposure, between new users of PPIs and other drugs excluding PPIs, by Cox proportional hazards model. We also analysed the incidence of gastric cancer among PPI users after H. pylori eradication.

Results The analysis included 11 741 patients in matched PPI and non-PPI cohorts after large-scale propensity score matching. During a median follow-up of 4.3 years, PPI use was associated with a 2.37-fold increased incidence of gastric cancer (PPI≥30 days vs non-PPI; 118/51 813 person-years vs 40/49 729 person-years; HR 2.37, 95% CI 1.56 to 3.68, p=0.001). The incidence rates of gastric cancer showed an increasing trend parallel to the duration of PPI use. In H. pylori-eradicated subjects, the incidence of gastric cancer was significantly associated with PPI use over 180 days compared with the non-PPI group (PPI≥180 days vs non-PPI; 30/12 470 person-years vs 9/7814 person-years; HR 2.22, 95% CI 1.05 to 4.67, p=0.036).

Conclusion PPI use was associated with gastric cancer, regardless of H. pylori eradication status. Long-term PPIs should be used with caution in high-risk regions for gastric cancer.

Association between proton pump inhibitor use and gastric cancer: a population-based cohort study using two different types of nationwide databases in Korea — https://gut.bmj.com/content/early/2021/05/11/gutjnl-2020-323845?rss=1
  • Prevacid 24HR
  • Nexium 24HR
  • Prilosec OTC
  • Zegerid OTC

OTC PPIs are only intended for a 14-day course of treatment and can be used up to three times per year.

Over-The-Counter (OTC) Heartburn Treatment — https://www.fda.gov/drugs/information-consumers-and-patients-drugs/over-counter-otc-heartburn-treatment

I was thinking of a snarky comment but decided against posting any snark.

But if you routinely pop a PPI before and/or after chowing down on a meat lover’s pizza you can’t say you weren’t advised that maybe it might be a better idea to give up the pizza.

Dumb and Dumber – Noncompliance with Colonoscopy Post Positive FIT

Results Some 88 013 patients who were FIT positive complied with colonoscopy (males: 56.1%; aged 50–59 years: 49.1%) while 23 410 did not (males: 54.6%; aged 50–59 years: 44.9%).

The 10-year cumulative incidence of CRC was 44.7 per 1000 (95% CI, 43.1 to 46.3) among colonoscopy compliers and 54.3 per 1000 (95% CI, 49.9 to 58.7) in non-compliers, while the cumulative mortality for CRC was 6.8 per 1000 (95% CI, 5.9 to 7.6) and 16.0 per 1000 (95% CI, 13.1 to 18.9), respectively. The risk of dying of CRC among non-compliers was 103% higher than among compliers (adjusted HR, 2.03; 95% CI, 1.68 to 2.44).

Conclusion The excess risk of CRC death among those not completing colonoscopy after a positive faecal occult blood test should prompt screening programmes to adopt effective interventions to increase compliance in this high-risk population.

Non-compliance with colonoscopy after a positive faecal immunochemical test doubles the risk of dying from colorectal cancer — https://gut.bmj.com/content/early/2021/03/30/gutjnl-2020-322192?rss=1

Help me understand human behavior. You get a positive FOBT or Cologuard test and your doctor says you need a colonoscopy but you decide not to follow up and follow through with the scope.

SMH.

NAFLD: not a benign disease

Non-alcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver disease worldwide, affecting at least a quarter of the global adult population. It is rapidly becoming one of the most common indications for liver transplantation in Western countries. NAFLD is widely considered as the hepatic manifestation of the metabolic syndrome. It is particularly common among patients with type 2 diabetes and obesity. Nonetheless, emerging data suggest that NAFLD is present in a significant proportion of lean individuals. In a systematic review and meta-analysis of 93 studies (involving over 10 million individuals), Ye et al found that 19.2% and 40.8% of patients with NAFLD were lean and non-obese, respectively, according to ethnic-specific body mass index (BMI) cut-offs.1 However, over 80% of the studies included in this systematic review were from Asia, raising the suspicion that NAFLD in lean individuals is a unique phenomenon among Asians, especially as Asians are known to have more central fat deposition and develop NAFLD and metabolic complications at a lower BMI.2

NAFLD in lean individuals: not a benign disease — https://gut.bmj.com/content/early/2021/03/11/gutjnl-2021-324162?rss=1

80% of the studies reviewed were from Asia which helps to explain why NAFLD was found in lean and non-obese people. I wonder how their diets have changed from traditional cuisines to cause this incidence level? Western style fast food?

Also see previous posts:

NAFLD – Why are Life Insurers Taking This Risk at Standard Rates?

NAFLD

NAFLD and Obesity: What Is the Mortality Risk? | Medpage Today

NAFLD = Higher Mortality Rate

Alkaline phosphatase 59 U/L, AST 28. ALT 10 as of September 2020. GGTP 36 as of December 2015. Sharing these numbers for all of my friends from the past who thought I would never live long enough to boast about these numbers.

Another Reason to GET VACCINATED

Since the early onset of the coronavirus pandemic, the loss or distortion of smell and taste have emerged as one of the telltale symptoms of COVID-19, with an estimated 86 percent of mild cases displaying signs of olfactory dysfunction. In many cases, patients cannot perceive smells (known as anosmia) — and with it the nuances of flavor inextricable from aroma — or any kind of taste (ageusia). In others, the dysfunction eventually manifests as warped senses of smell and taste (parosmia and parageusia, respectively), rendering previously familiar scents and flavors rancid, like being assaulted with the overwhelming stench of rot, feces, and chemicals.

We Asked People Who Lost Their Taste to COVID: What Do You Eat in a Day? — https://www.eater.com/2021/2/5/22267667/covid-19-loss-distorted-taste-smell-anosmia-parosmia-symptom-food-diaries

Interesting set of short interviews with some long haul Covid-19 sufferers. Think about it. What do you eat when everything tastes like crap?

Poor gut health is Associated With Severe COVID-19

In a review published this week in mBio, microbiologist Heenam Stanley Kim, Ph.D, from Korea University’s Laboratory for Human-Microbial Interactions, in Seoul, examined emerging evidence suggesting that poor gut health adversely affects COVID-19 prognosis. Based on his analysis, Kim proposed that gut dysfunction — and its associated leaky gut — may exacerbate the severity of infection by enabling the virus to access the surface of the digestive tract and internal organs. These organs are vulnerable to infection because they have widespread ACE2 — a protein target of SARS-CoV-2 — on the surface.”There seems to be a clear connection between the altered gut microbiome and severe COVID-19,” Kim said.

American Society for Microbiology. “Poor gut health connected to severe COVID-19, new review shows.” ScienceDaily. http://www.sciencedaily.com/releases/2021/01/210112085347.htm (accessed January 15, 2021).

Journal Reference: Heenam Stanley Kim. Do an Altered Gut Microbiota and an Associated Leaky Gut Affect COVID-19 Severity? mBio, 2021; 12 (1) DOI: 10.1128/mBio.03022-20

Eat more legumes, plants and other sources of dietary fiber.

Eat less meat, dairy, and eggs.

NAFLD – Why are Life Insurers Taking This Risk at Standard Rates?

Conclusion All NAFLD histological stages were associated with significantly increased overall mortality, and this risk increased progressively with worsening NAFLD histology. Most of this excess mortality was from extrahepatic cancer and cirrhosis, while in contrast, the contributions of cardiovascular disease and HCC were modest.

Mortality in biopsy-confirmed nonalcoholic fatty liver disease: results from a nationwide cohort — https://gut.bmj.com/content/early/2020/10/09/gutjnl-2020-322786?rss=1

Diet. That’s it. That’s my post.

Meat Intake and Colorectal Polyps

Meat Intake and Colorectal Polyps

Research professor of medicine Martha Shrubsole, Ph.D., and colleagues at Vanderbilt University Medical Center have published the first study to evaluate intakes of meat, cooking methods and meat mutagens and risk of developing sessile serrated polyps (SSPs, also called sessile serrated lesions). Shrubsole previously reported that consuming high levels of red meat increased the risk of developing all types of polyps, but that the likelihood of developing SSPs was two times greater than the risk of developing adenomas and hyperplastic polyps (HP).

Conventional colorectal adenomas are the precursor lesions for most colorectal cancers. SSPs, however, represent an alternative pathway to carcinogenesis that may account for up to 35 percent of colorectal cancers. Because a diagnostic consensus for SSPs was not reached until 2010, few epidemiologic studies have evaluated risk factors.

 

Any Polyp Type Raises CRC Risk

A finding of any type of polyp in the colon increases the risk for colorectal cancer (CRC), according to new findings from a large Swedish study.

At 10 years, the cumulative colorectal cancer incidence was 1.6% among patients with hyperplastic polyps, 2.5% among those with sessile serrated polyps, 2.7% for tubular adenomas, 5.1% for tubulovillous adenomas, and 8.6% for villous adenomas, as compared with 2.1% for the control group.

However, a higher risk for colorectal-related death was only observed in patients with sessile serrated polyps, tubulovillous adenomas, or villous adenomas.

The study was published online March 16 in Lancet Gastroenterology & Hepatology.

Any Type of Polyp Increases the Risk for Colorectal Cancer

Boldface sections are mine.

I had my first virtual visit with my physician yesterday.  I mentioned that I was postponing my colonoscopy this year for pandemic reasons.  She said that’s fine, don’t worry about it.  I read this article today.  Now I know why I’m on a three year callback.