NAFLD is one of the most important causes of liver disease worldwide and will probably emerge as the leading cause of end-stage liver disease in the coming decades, with the disease affecting both adults and children. The epidemiology and demographic characteristics of NAFLD vary worldwide, usually parallel to the prevalence of obesity, but a substantial proportion of patients are lean. The large number of patients with NAFLD with potential for progressive liver disease creates challenges for screening, as the diagnosis of NASH necessitates invasive liver biopsy. Furthermore, individuals with NAFLD have a high frequency of metabolic comorbidities and could place a growing strain on health-care systems from their need for management. While awaiting the development effective therapies, this disease warrants the attention of primary care physicians, specialists and health policy makers.

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Global burden of NAFLD and NASH: trends, predictions, risk factors and prevention

https://www.journal-of-hepatology.eu/article/S0168-8278(18)32388-2/pdf

Burden of liver diseases in the world

https://research.birmingham.ac.uk/portal/files/98025484/1_s2.0_S0168827820302014_main.pdf

A new definition for metabolic dysfunction-associated fatty liver disease: An international expert consensus statement.

There is great geographical variation in the distribution of hepatocellular carcinoma (HCC), with the majority of all cases worldwide found in the Asia–Pacific region, where HCC is one of the leading public health problems. Since the “Toward Revision of the Asian Pacific Association for the Study of the Liver (APASL) HCC Guidelines” meeting held at the 25th annual conference of the APASL in Tokyo, the newest guidelines for the treatment of HCC published by the APASL has been discussed. This latest guidelines recommend evidence-based management of HCC and are considered suitable for universal use in the Asia–Pacific region, which has a diversity of medical environments.

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Asia–Pacific clinical practice guidelines on the management of hepatocellular carcinoma: a 2017 update

Non-alcoholic fatty liver disease - A global public health perspective.

Comment to: “EASL-EASD-EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease”

CONTEXT: Esophageal cancer is often diagnosed at an advanced stage and has a poor prognosis. Most patients with advanced esophageal cancer have significant dysphagia that contributes to weight loss and malnutrition. Esophageal stenting is a widespread palliation approach, but unsuitable for cancers near the upper esophageal sphincter, were stents are poorly tolerated. Generally, guidelines do not support endoscopic gastrostomy in this clinical setting, but it may be the best option for nutritional support. OBJECTIVE: Retrospective evaluation of patients with dysphagia caused advanced esophageal cancer, no expectation of resuming oral intake and with percutaneous endoscopic gastrostomy for comfort palliative nutrition. METHOD: We selected adult patients with unresecable esophageal cancer histological confirmed, in whom stenting was impossible due to proximal location, and chemotherapy or radiotherapy were palliative, using gastrostomy for enteral nutrition. Clinical and nutritional data were evaluated, including success of gastrostomy, procedure complications and survival after percutaneous endoscopic gastrostomy, and evolution of body mass index, albumin, transferrin and cholesterol. RESULTS: Seventeen males with stage III or IV squamous cell carcinoma fulfilled the inclusion criteria. Mean age was 60.9 years. Most of the patients had toxic habits. All underwent palliative chemotherapy or radiotherapy. Gastrostomy was successfully performed in all, but nine required prior dilatation. Most had the gastrostomy within 2 months after diagnosis. There was a buried bumper syndrome treated with tube replacement and four minor complications. There were no cases of implantation metastases or procedure related mortality. Two patients were lost and 12 died. Mean survival of deceased patients was 5.9 months. Three patients are alive 6, 14 and 17 months after the gastrostomy procedure, still increasing the mean survival. Mean body mass index and laboratory parameters were roughly stable 1 and 3 months after the gastrostomy procedure. CONCLUSIONS: In patients with advanced upper esophageal cancer where only palliative treatment is possible, nutritional support is easily achieved with percutaneous endoscopic gastrostomy, allowing patients to be at homes, surviving a significant period of time. Percutaneous endoscopic gastrostomy feeding should be considered as standard definitive nutritional palliation in patients with upper esophageal cancer, unsuitable for esophageal stenting.

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Percutaneous endoscopic gastrostomy for nutritional palliation of upper esophageal cancer unsuitable for esophageal stenting

Head and neck cancer (HNC) patients who underwent percutaneous endoscopic gastrostomy (PEG) present malnutrition risk and speech impairments. Their assessment relies on objective anthropometric/laboratory data. Focusing on HNC PEG patients, our aims were to evaluate: 1) outcome; 2) nutritional status when the patients underwent PEG; and 3) association of nutritional status/outcome, creating a survival predictive model. We evaluated the outcome based on NRS 2002, dietary assessment, body mass index (BMI), mid-upper arm circumference (MUAC), triceps skinfold thickness (TSF), mid-arm muscle circumference (MAMC), albumin, transferrin, and cholesterol on the day of gastrostomy. Using BMI, TSF, MAMC, and laboratory data, a survival predictive model was created. Of the 234 patients (cancer stages III–IV), 149 died, 33 were still PEG-fed, and 36 resumed oral intake (NRS-2002≥3, caloric needs <50% in all). BMI was 12.7–43. 189, 197, and 168 patients displayed, respectively, low MUAC, TSF, and MAMC. 91, 155...

Malnutrition and Clinical Outcome of 234 Head and Neck Cancer Patients who Underwent Percutaneous Endoscopic Gastrostomy

Introduction Gastrostomy fed head or neck cancer patients frequently have impaired speech capacities. Enteral feeding teams frequently depend on laboratorial or anthropometrical parameters for nutritional assessment. Aims In these patients, this study aimed to evaluate: (1) the practicability of Scored - Patient-Generated Subjective Global Assessment (PG-SGA); (2) their nutritional status using the Scored-PG-SGA; (3) association of serum albumin and transferrin values to the nutritional status rating using PG-SGA. Methods On adult outpatients with head or neck cancer under prolonged (> 1 month) gastrostomy feeding, Scored-PGSGA, albumin and transferrin were evaluated during the same appointment. Results Scored-PG-SGA was easily feasible in 42 patients, even in patients with speech difficulties. Twenty-five patients were moderately/severely undernourished (PG-SGA/B+C). Scored-PG-SGA rated 41 patients as ≥ 2, thus needing nutritional/ pharmacologic intervention. Albumin was low in 13 patients. Transferrin was low in 19 patients. Average albumin and transferrin in moderately/severely undernourished patients (PG-SGA/B+C) was significantly lower than in well-nourished (PG-SGA/A). There was association between Scored- PG-SGA rating, albumin and transferrin. Conclusions In PEG fed head or neck cancer patients, PGSGA was practicable and useful, even in patients with impaired speaking skills. Most patients displayed moderate/severe malnutrition (PG-SGA/B+C). Scored-PG-SGA rated 41 patients as needing for nutritional/pharmacological intervention. Scored-PG-SGA should be systematically included in the evaluation of these patients. In these patients, albumin and transferrin levels showed relation with Scored-PG-SGA and should be considered as nutritional biomarkers.

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Scored Patient-Generated Subjective Global Assessment, albumin and transferrin for nutritional assessment of gastrostomy fed head or neck cancer patients.

espanolIntroduccion: la disfagia es comun en pacientes con esclerosis lateral amiotrofi ca (ELA) y pude resultar en desnutricion. Se recomienda la gastrostomia endoscopica (PEG) cuando la alimentacion oral no es mas segura. Este trabajo tiene como objetivo evaluar la efi cacia y seguridad de la alimentacion por PEG en la mejora de los parametros nutricionales y de pronostico en pacientes con ELA. Metodos: estudio observacional y retrospectivo que utilizo los registros clinicos de pacientes con ELA referidos para gastrostomia. Se recogieron datos sobre la edad, el genero y la mortalidad. Se registro el NRS 2002, el indice de masa corporal (IMC), la albumina serica, la transferrina y el colesterol total en el momento de PEG (T0) y despues de 3 meses (T3). Resultados: fueron recolectados los datos de 37 pacientes con ELA (18 hombres/19 mujeres), con edades comprendidas entre 43-88 anos (media: 69 anos). Todos los pacientes presentaron NRS 2002 ≥ 3 puntos. En promedio, los pacientes fueron sometidos a gastrostomia 11 meses despues del diagnostico. No hubo complicaciones mayores del procedimiento. La media de supervivencia despues del diagnostico de ELA fue de 22,2 meses. La tasa de mortalidad a los 3 meses fue de 21,6%, con una supervivencia media de 1,.2 meses despues de PEG. Los niveles de albumina, transferrina y colesterol aumentaron de T0 a T3, sin embargo sin alcanzar significacion estadistica. Mayores niveles de albumina (R = 0,3) y de transferrina sericas (R = 0,4) en el momento de PEG tienden a estar correlacionados positivamente con una supervivencia mas larga. El IMC medio fue similar en los dos momentos, pero valores iniciales mas altos estan asociados con un mejor pronostico (R2 = 0,39, p Conclusiones: PEG es una tecnica segura y efi caz para la nutricion enteral y se debe considerar temprano en pacientes con ELA y disfagia. Un mayor IMC predice una mayor supervivencia. La asociacion entre proteinas sericas mas altas y la supervivencia debe ser confirmada en estudios posteriores. EnglishBackground: Dysphagia is common in amyotrophic lateral sclerosis (ALS) and may result in malnutrition. Endoscopic gastrostomy (PEG) is recommended when oral feeding is unsafe. This work aims to assess the effectiveness and safety of PEG feeding on improving nutritional and prognostic parameters in ALS patients. Methods: Observational and retrospective study using records from ALS patients referred for gastrostomy. Age, gender and mortality data were collected. NRS 2002, body mass index (BMI), serum albumin, transferrin and total cholesterol were recorded at the time of PEG (T0) and repeated after 3 months (T3). The evolution of these parameters was analysed and compared to survival. Results: Data from 37 ALS patients (18 men/19 women) aged 43-88 years (mean: 69 years). All patients presented NRS 2002 ≥ 3 points. On average, patients underwent gastrostomy 11 months after diagnosis. No major procedural complications occurred. Mean survival after diagnosis was 22.2 months. Mortality rate at 3 months was 21.6% with a mean survival after PEG of 11.2 months. Albumin, transferrin and cholesterol levels increased from T0 to T3 without reaching statistical signifi cance. Higher albumin (R = 0.3) and transferrin (R = 0.4) at admission tend to be positively correlated with survival. Mean BMI was similar at the two moments but higher initial values were associated with better outcome (R2 = 0.39, p Conclusions: PEG is a safe and effective technique for enteral feeding and should be considered early in ALS patients with dysphagia. Higher BMI predicts longer survival. The association between higher serum proteins and survival must be confi rmed in further studies.

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Carla Adriana Santos

Papers

Comment to: “EASL-EASD-EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease”

Percutaneous endoscopic gastrostomy for nutritional palliation of upper esophageal cancer unsuitable for esophageal stenting

Malnutrition and Clinical Outcome of 234 Head and Neck Cancer Patients who Underwent Percutaneous Endoscopic Gastrostomy

Scored Patient-Generated Subjective Global Assessment, albumin and transferrin for nutritional assessment of gastrostomy fed head or neck cancer patients.

Enteral feeding through endoscopic gastrostomy in amyotrophic lateral sclerosis patients.