The Fatty Liver Assessment in Germany (FLAG) cohort study identifies large heterogeneity in NAFLD care
Background & Aims: NAFLD is a growing health concern. The aim of the Fatty Liver Assessment in Germany (FLAG) study was to assess disease burden and provide data on the standard of care from secondary care. Methods: The FLAG study is an observational real-world study in patients with NAFLD e...
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Elsevier
2020-12-01
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Online Access: | http://www.sciencedirect.com/science/article/pii/S2589555920301026 |
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record_format |
Article |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Wolf Peter Hofmann Peter Buggisch Lisa Schubert Nektarios Dikopoulos Jeannette Schwenzer Marion Muche Gisela Felten Renate Heyne Patrick Ingiliz Anna Schmidt Kerstin Stein Heiner Wedemeyer Thomas Berg Johannes Wiegand Frank Lammert Stefan Zeuzem Jörn M. Schattenberg |
spellingShingle |
Wolf Peter Hofmann Peter Buggisch Lisa Schubert Nektarios Dikopoulos Jeannette Schwenzer Marion Muche Gisela Felten Renate Heyne Patrick Ingiliz Anna Schmidt Kerstin Stein Heiner Wedemeyer Thomas Berg Johannes Wiegand Frank Lammert Stefan Zeuzem Jörn M. Schattenberg The Fatty Liver Assessment in Germany (FLAG) cohort study identifies large heterogeneity in NAFLD care JHEP Reports NASH NAFLD Real world Metabolic syndrome Liver fibrosis Co-morbidities |
author_facet |
Wolf Peter Hofmann Peter Buggisch Lisa Schubert Nektarios Dikopoulos Jeannette Schwenzer Marion Muche Gisela Felten Renate Heyne Patrick Ingiliz Anna Schmidt Kerstin Stein Heiner Wedemeyer Thomas Berg Johannes Wiegand Frank Lammert Stefan Zeuzem Jörn M. Schattenberg |
author_sort |
Wolf Peter Hofmann |
title |
The Fatty Liver Assessment in Germany (FLAG) cohort study identifies large heterogeneity in NAFLD care |
title_short |
The Fatty Liver Assessment in Germany (FLAG) cohort study identifies large heterogeneity in NAFLD care |
title_full |
The Fatty Liver Assessment in Germany (FLAG) cohort study identifies large heterogeneity in NAFLD care |
title_fullStr |
The Fatty Liver Assessment in Germany (FLAG) cohort study identifies large heterogeneity in NAFLD care |
title_full_unstemmed |
The Fatty Liver Assessment in Germany (FLAG) cohort study identifies large heterogeneity in NAFLD care |
title_sort |
fatty liver assessment in germany (flag) cohort study identifies large heterogeneity in nafld care |
publisher |
Elsevier |
series |
JHEP Reports |
issn |
2589-5559 |
publishDate |
2020-12-01 |
description |
Background & Aims: NAFLD is a growing health concern. The aim of the Fatty Liver Assessment in Germany (FLAG) study was to assess disease burden and provide data on the standard of care from secondary care. Methods: The FLAG study is an observational real-world study in patients with NAFLD enrolled at 13 centres across Germany. Severity of disease was assessed by non-invasive surrogate scores and data recorded at baseline and 12 months. Results: In this study, 507 patients (mean age 53 years; 47% women) were enrolled. According to fibrosis-4 index, 64%, 26%, and 10% of the patients had no significant fibrosis, indeterminate stage, and advanced fibrosis, respectively. Patients with advanced fibrosis were older, had higher waist circumferences, and higher aspartate aminotransferase and gamma-glutamyltransferase as well as ferritin levels. The prevalence of obesity, arterial hypertension, and type 2 diabetes increased with fibrosis stages. Standard of care included physical exercise >2 times per week in 17% (no significant fibrosis), 19% (indeterminate), and 6% (advanced fibrosis) of patients. Medication with either vitamin E, silymarin, or ursodeoxycholic acid was reported in 5%. Approximately 25% of the patients received nutritional counselling. According to the FibroScan-AST score, 17% of patients presented with progressive non-alcoholic steatohepatitis (n = 107). On follow-up at year 1 (n = 117), weight loss occurred in 47% of patients, of whom 17% lost more than 5% of body weight. In the weight loss group, alanine aminotransferase activities were reduced by 20%. Conclusions: This is the first report on NAFLD from a secondary-care real-world cohort in Germany. Every 10th patient presented with advanced fibrosis at baseline. Management consisted of best supportive care and lifestyle recommendations. The data highlight the urgent need for systematic health agenda in NAFLD patients. Lay summary: FLAG is a real-world cohort study that examined the liver disease burden in secondary and tertiary care. Herein, 10% of patients referred to secondary care for NAFLD exhibited advanced liver disease, whilst 64% had no significant liver scarring. These findings underline the urgent need to define patient referral pathways for suspected liver disease. |
topic |
NASH NAFLD Real world Metabolic syndrome Liver fibrosis Co-morbidities |
url |
http://www.sciencedirect.com/science/article/pii/S2589555920301026 |
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doaj-90039f920306409aa229b55d51c9a63b2020-11-25T02:52:41ZengElsevierJHEP Reports2589-55592020-12-0126100168The Fatty Liver Assessment in Germany (FLAG) cohort study identifies large heterogeneity in NAFLD careWolf Peter Hofmann0Peter Buggisch1Lisa Schubert2Nektarios Dikopoulos3Jeannette Schwenzer4Marion Muche5Gisela Felten6Renate Heyne7Patrick Ingiliz8Anna Schmidt9Kerstin Stein10Heiner Wedemeyer11Thomas Berg12Johannes Wiegand13Frank Lammert14Stefan Zeuzem15Jörn M. Schattenberg16Gastroenterologie am Bayerischen Platz, Berlin, Germany; Association of Gastroenterologists in Private Practice (Berufsverband Niedergelassener Gastroenterologen Deutschlands), Ulm, GermanyAssociation of Gastroenterologists in Private Practice (Berufsverband Niedergelassener Gastroenterologen Deutschlands), Ulm, Germany; IFI Institut für interdisziplinäre Medizin, Hamburg, GermanyGastroenterologie am Bayerischen Platz, Berlin, Germany; Medical Department (Gastroenterology, Infectiology, Rhumatology) Charité Campus Benjamin Franklin, Berlin, GermanyGastroenterologische Schwerpunktpraxis, Dornstadt, GermanyBauchzentrum Biesdorf, Berlin, GermanyMedical Department (Gastroenterology, Infectiology, Rhumatology) Charité Campus Benjamin Franklin, Berlin, GermanyGastroenterologische Praxis Herne, Herne, GermanyLeberzentrum am Checkpoint, Berlin, GermanyZentrum für Infektiologie Prenzlauer Berg, Berlin, GermanyMagen-Darm-Zentrum Wiener Platz, Cologne, GermanyPraxis für Infektiologie und Hepatologie Magdeburg, Magdeburg, GermanyDepartment of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, GermanyDivision of Hepatology, Department of Medicine II, Leipzig University Hospital, Leipzig, GermanyDivision of Hepatology, Department of Medicine II, Leipzig University Hospital, Leipzig, GermanyDepartment of Medicine II, Saarland University Hospital, Homburg, GermanyDepartment of Internal Medicine, Goethe University Hospital Frankfurt, Frankfurt, GermanyI. Department of Medicine, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany; Metabolic Liver Research Program, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany; Corresponding author. Address: Metabolic Liver Research Program, I. Department of Medicine, University Medical Centre of the Johannes Gutenberg-University, Langenbeckstr. 1, 55131 Mainz, Germany. Tel.: +49 (0) 6131 17 6074; fax: +49 (0) 6131 17 477282.Background & Aims: NAFLD is a growing health concern. The aim of the Fatty Liver Assessment in Germany (FLAG) study was to assess disease burden and provide data on the standard of care from secondary care. Methods: The FLAG study is an observational real-world study in patients with NAFLD enrolled at 13 centres across Germany. Severity of disease was assessed by non-invasive surrogate scores and data recorded at baseline and 12 months. Results: In this study, 507 patients (mean age 53 years; 47% women) were enrolled. According to fibrosis-4 index, 64%, 26%, and 10% of the patients had no significant fibrosis, indeterminate stage, and advanced fibrosis, respectively. Patients with advanced fibrosis were older, had higher waist circumferences, and higher aspartate aminotransferase and gamma-glutamyltransferase as well as ferritin levels. The prevalence of obesity, arterial hypertension, and type 2 diabetes increased with fibrosis stages. Standard of care included physical exercise >2 times per week in 17% (no significant fibrosis), 19% (indeterminate), and 6% (advanced fibrosis) of patients. Medication with either vitamin E, silymarin, or ursodeoxycholic acid was reported in 5%. Approximately 25% of the patients received nutritional counselling. According to the FibroScan-AST score, 17% of patients presented with progressive non-alcoholic steatohepatitis (n = 107). On follow-up at year 1 (n = 117), weight loss occurred in 47% of patients, of whom 17% lost more than 5% of body weight. In the weight loss group, alanine aminotransferase activities were reduced by 20%. Conclusions: This is the first report on NAFLD from a secondary-care real-world cohort in Germany. Every 10th patient presented with advanced fibrosis at baseline. Management consisted of best supportive care and lifestyle recommendations. The data highlight the urgent need for systematic health agenda in NAFLD patients. Lay summary: FLAG is a real-world cohort study that examined the liver disease burden in secondary and tertiary care. Herein, 10% of patients referred to secondary care for NAFLD exhibited advanced liver disease, whilst 64% had no significant liver scarring. These findings underline the urgent need to define patient referral pathways for suspected liver disease.http://www.sciencedirect.com/science/article/pii/S2589555920301026NASHNAFLDReal worldMetabolic syndromeLiver fibrosisCo-morbidities |