Low alcohol consumption increases the risk of impaired glucose tolerance in patients with non-alcoholic fatty liver disease

Abstract

Background

Fatty liver disease is associated with glucose intolerance and hepatic insulin resistance. However, there are distinct etiologies for alcoholic versus non-alcoholic fatty liver disease (NAFLD), and it is unknown whether alcohol consumption influences the onset of glucose intolerance in fatty liver disease patients. Therefore, we investigated the relationship between fatty liver disease and the onset of impaired fasting glucose (IFG) with respect to alcohol consumption.

Methods

The records of 6804 Japanese subjects were reviewed to identify those meeting the criteria for IFG. Male and female subjects were classified into five and four groups, respectively, based on average alcohol consumption (g/week). IFG onset was defined as fasting plasma glucose levels ≥110 mg/dl.

Results

In the non-drinker, >0–70 g/week, >70–140 g/week, >140–210 g/week (men only), and >210 g/week (men only) or >140 g/week (women only) groups, 7.3, 6.7, 6.4, 9, and 6.4 % of men and 2, 1.7, 3.1, and 3.2 % of women, respectively, developed IFG. Fatty liver was positively associated with the onset of IFG in men of the >0–70 g/week group (adjusted hazard ratio [aHR], 2.808; 95 % confidence interval [CI] 1.605–5.049, p < 0.001) and women of the >70–140 g/week group (aHR, 4.193; 95 % CI, 1.036–14.584, p = 0.045) after adjusting for previously reported IFG risk factors. No associations were observed in the other groups.

Conclusions

A small amount of alcohol consumption is a significant risk factor for the onset of IFG in NAFLD patients; onset risk differs according to the amount of alcohol consumption.

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Could ‘Aunties’ Recruit Pregnant Indigenous Women Who Smoke Into a Trial and Deliver a Cessation Intervention? A Feasibility Study

Abstract

Objective Māori (indigenous New Zealand) women have the highest smoking prevalence rates in New Zealand and whilst pregnant. We hypothesized that community health workers ('Aunties') could find pregnant Māori women who smoke, recruit them into a study and deliver an acceptable cessation intervention. The aim of the study was to test the feasibility of such an intervention. Method A community health organization was engaged to, using a participatory approach, conduct a feasibility study. Participants were ten Aunties and the pregnant women the Aunties recruited. The Aunties advised their participants to abstain from smoking, offered a Quitcard (for subsidized nicotine replacement) or referral to local cessation providers. A booklet on healthy eating for pregnancy was given and discussed and the Aunties offered help if needed to register with a lead maternity carer (LMC). All women completed a baseline questionnaire. Semi-structured follow up face-to-face interviews were conducted with a subsample of women and hospital birth records were examined. Descriptive statistics were produced using quantitative data. Qualitative data was deductively analysed. Results During 4 months eight Aunties recruited 67 pregnant women who smoked, 88 % were Māori, 84 % were of low socio economic status and 73 % had up to high school education. Only 36 % of the recruited women had registered with an LMC. The participants described the Aunties as supportive, nice and non-judgmental. The only criticism was a lack of follow up. Aspects of the intervention that the Aunties thought worked well were knowing and being involved with their community, and being able to give a gift pack to the participating women. Insufficient follow up was one aspect that didn't work well. The infant's birth record was found for 54 % of the participants. Conclusion Aunties were able to identify and recruit pregnant Māori women who smoked. The study method and intervention were acceptable to Aunties and participants and it was feasible to collect data from the participants' hospital birth records. Based on this study, with a similar number of Aunties recruiting, it would take 2 years to recruit over 300 participants, which would be sufficient for a stronger controlled trial.

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Access to Money and Relation to Women’s Use of Family Planning Methods Among Young Married Women in Rural India

Abstract

Objectives The social positioning (i.e. social status and autonomy) of women in the household facilitates women's access to and decision-making power related to family planning (FP). Women's access to spending money, which may be an indicator of greater social positioning in the household, may also be greater among women who engage in income generating activities for their families, regardless of women's status in the household. However, in both scenarios, access to money may independently afford greater opportunity to obtain family planning services among women. This study seeks to assess whether access to money is associated with FP outcomes independently of women's social positioning in their households. Methods Using survey data from married couples in rural Maharashtra, India (n = 855), crude and adjusted regression was used to assess women's access to their own spending money in relation to past 3 month use of condoms and other forms of contraceptives (pills, injectables, intrauterine device). Results Access to money (59 %) was associated with condom and other contraceptive use (AORs ranged 1.5–1.8). These findings remained significant after adjusting for women's FP decision-making power in the household and mobility to seek FP services. Conclusion While preliminary, findings suggest that access to money may increase women's ability to obtain FP methods, even in contexts where social norms to support women's power in FP decision-making may not be readily adopted.

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Association Between Low Dairy Intake During Pregnancy and Risk of Small-for-Gestational-Age Infants

Abstract

Background Inadequate maternal nutrition is regarded as one of the most important indicators of fetal growth. The aim of this study was to analyze the associated risk of having a small for gestational age (SGA) infant according to the mother's dairy intake during the first half of pregnancy. Methods A prospective cohort study was performed using 1175 healthy pregnant women selected from the catchment area of Virgen de las Nieves University Hospital, Granada (Spain). SGA was defined as neonates weighing less than the 10th percentile, adjusted for gestational age. Factors associated with SGA were analyzed using logistic regression models. Population attributable fractions of SGA according to dairy intake were estimated. Results Dairy intake among women who gave birth to SGA infants was 513.9, versus 590.3 g/day for women with appropriate size for gestational age infants (P = 0.003). An increased intake of dairy products by 100 g/day during the first half of pregnancy decreased the risk of having a SGA infant by 11.0 %, aOR = 0.89 (0.83, 0.96). A dose–response gradient between dairy intake and SGA was observed. Conclusions An inadequate intake of dairy products is associated with a higher risk of SGA. Our results suggest a possible causal relation between dairy intake during pregnancy and the weight of the newborn, although we cannot discard residual confounding. These results should be further supported by properly designed studies.

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Risk Factors Such as Male Sex, Smoking, Metabolic Syndrome, Obesity, and Fatty Liver Do Not Justify Screening Colonoscopies Before Age 45

Abstract

Background

Recently, many studies have reported that male sex, smoking, fatty liver, metabolic syndrome (MetS), and obesity are risk factors for colorectal neoplasia (CRN). However, current guidelines recommend that persons at average risk of colorectal cancer begin screening colonoscopy at age 50 years without consideration of those risk factors.

Aim

To investigate an appropriate time to start screening colonoscopies in persons with risk factors for CRN.

Methods

We performed a cross-sectional study on 27,894 Korean aged ≥30 years who underwent a first colonoscopy as part of a health screening program. To compare the efficacy of colonoscopic screening for the detection of advanced CRN among age groups with risk factors, we calculated the number needed to screen (NNS) to identify 1 patient with advanced CRN.

Results

The NNS for those 30–39 years old with all risk factors, male gender, smoking (≥10 pack-years), MetS, obesity, and fatty liver, was higher than that for ≥50-year-old female subjects (55.4 vs. 26.4). The NNS for those 40–44 years old with all risk factors (37.1) was also higher than that for ≥50-year-old female subjects. However, the NNS for those 45–49 years old with risk factors (16.9–22.9) was lower than that for ≥50-year-old women.

Conclusions

The efficacy of colonoscopic screening in people 30–44 years old with multiple risk factors is lower than that in ≥50-year-old women. Risk factors such as male sex, smoking, MetS, obesity, and fatty liver do not justify starting screening colonoscopies before age 45.

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Erratum to: Low Alpha-Fetoprotein Levels Are Associated with Improved Survival in Hepatocellular Carcinoma Patients with Portal Vein Thrombosis

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Psoriasiform Skin Lesions Are Caused by Both Infliximab and Adalimumab in a Patient with Crohn’s Disease

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Universal Screening of Colorectal Cancers for Lynch Syndrome: Challenges and Opportunities

Abstract

Lynch syndrome (LS) is the most common heritable colorectal cancer (CRC) syndrome, accounting for approximately 3 % of CRC cases in the USA each year. LS results from a genetic mutation in one of the four mismatch repair genes, and clinically LS is associated with CRC and other gastrointestinal and extra-gastrointestinal malignancies. In this review, we describe the various clinical criteria utilized for the identification of LS patients and the inherent flaws with these criteria. We discuss the concept of universal testing for LS in all cases of newly diagnosed CRC, along with the potential benefits and challenges of universal testing. Several studies have shown that universal tumor testing is cost-effective and identifies cases of LS that are missed using traditional clinical criteria, which may result in reduced cancer mortality for probands and their families. Yet the full benefits of universal tumor testing may be limited by the availability and patient acceptance of genetic testing, and by logistical obstacles affecting the implementation of universal testing programs. Lastly, we comment on developing technologies such as massively parallel next-generation sequencing, which permits simultaneous sequencing of multiple genes involved in LS and other inherited colon cancer syndromes.

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Comparison of Outcomes and Complications of Endoscopic Common Bile Duct Stone Removal Between Asymptomatic and Symptomatic Patients

Abstract

Introduction

Endoscopic retrograde cholangiopancreatography (ERCP) is generally recommended for removal of CBD stones. There were no studies focusing on the role of symptoms related to CBD stone in performing endoscopic stone removal. The aim of our study was to compare outcomes and complications of ERCP between asymptomatic and symptomatic CBD stones.

Methods

The medical records of 568 patients with naïve papilla who underwent ERCP for treatment of CBD stone from Jan 2009 to Aug 2014 were reviewed and analyzed retrospectively. Patients were divided as asymptomatic group (n = 32) and symptomatic group (n = 536).

Results

Age and gender were not significantly different between the two groups (p > 0.005). Mean sizes of CBD and CBD stones were not significantly different between asymptomatic and symptomatic group (p > 0.05). No differences in performance of needle knife fistulotomy, endoscopic sphincterotomy, and endoscopic papillary balloon dilatation were observed between the two groups (p > 0.05). Unintentional injection into the pancreatic duct was not significantly different between the two groups (p > 0.05). The overall complete stone removal rate was 96.9 % in the asymptomatic group and 94.4 % in the symptomatic group (p = 0.295). Requirement of mechanical lithotripsy was not significantly different between asymptomatic and symptomatic group (18.8 vs 8.4 %, p = 0.057). Significantly higher incidence of post-ERCP pancreatitis was observed in the asymptomatic group than in the symptomatic group (12.5 vs 3.9 %, p = 0.045).

Conclusion

The overall success rates of CBD stone removal were comparable between asymptomatic and symptomatic patients. However, risk of post-ERCP pancreatitis appears to be increased in patients with asymptomatic CBD stones.

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Cystic Fibrosis Associated with Worse Survival After Liver Transplantation

Abstract

Background

Survival in cystic fibrosis patients after liver transplantation and liver–lung transplantation is not well studied.

Aims

To discern survival rates after liver transplantation and liver–lung transplantation in patients with and without cystic fibrosis.

Methods

The United Network for Organ Sharing database was queried from 1987 to 2013. Univariate Cox proportional hazards, multivariate Cox models, and propensity score matching were performed.

Results

Liver transplant and liver–lung transplant were performed in 212 and 53 patients with cystic fibrosis, respectively. Univariate Cox proportional hazards regression identified lower survival in cystic fibrosis after liver transplant compared to a reference non-cystic fibrosis liver transplant cohort (HR 1.248; 95 % CI 1.012, 1.541; p = 0.039). Supplementary analysis found graft survival was similar across the 3 recipient categories (log-rank test: χ² 2.68; p = 0.262). Multivariate Cox models identified increased mortality hazard among cystic fibrosis patients undergoing liver transplantation (HR 2.439; 95 % CI 1.709, 3.482; p < 0.001) and liver–lung transplantation (HR 2.753; 95 % CI 1.560, 4.861; p < 0.001). Propensity score matching of cystic fibrosis patients undergoing liver transplantation to non-cystic fibrosis controls identified a greater mortality hazard in the cystic fibrosis cohort using a Cox proportional hazards model stratified on matched pairs (HR 3.167; 95 % CI 1.265, 7.929, p = 0.014).

Conclusions

Liver transplantation in cystic fibrosis is associated with poorer long-term patient survival compared to non-cystic fibrosis patients, although the difference is not due to graft survival.

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